Pathophysiology of Hypertension: The Mosaic Theory and Beyond

Circ Res. 2021 Apr 2;128(7):847-863. doi: 10.1161/CIRCRESAHA.121.318082. Epub 2021 Apr 1.

Abstract

Dr Irvine Page proposed the Mosaic Theory of Hypertension in the 1940s advocating that hypertension is the result of many factors that interact to raise blood pressure and cause end-organ damage. Over the years, Dr Page modified his paradigm, and new concepts regarding oxidative stress, inflammation, genetics, sodium homeostasis, and the microbiome have arisen that allow further refinements of the Mosaic Theory. A constant feature of this approach to understanding hypertension is that the various nodes are interdependent and that these almost certainly vary between experimental models and between individuals with hypertension. This review discusses these new concepts and provides an introduction to other reviews in this compendium of Circulation Research.

Keywords: blood pressure; history; hypertension; inflammation; reactive oxygen species.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aldosterone / physiology
  • Angiotensin II / pharmacology
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Blood Vessels / physiology
  • Body Fluids / physiology
  • Central Nervous System / physiology
  • Humans
  • Hypertension / etiology
  • Hypertension / physiopathology*
  • Inflammation / complications
  • Kidney / physiology
  • Microbiota / physiology
  • Reactive Oxygen Species / metabolism
  • Risk Factors
  • Sodium Chloride / administration & dosage
  • Sodium Chloride / adverse effects
  • Vasoconstrictor Agents / pharmacology

Substances

  • Reactive Oxygen Species
  • Vasoconstrictor Agents
  • Angiotensin II
  • Sodium Chloride
  • Aldosterone