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Current views concerning cardiac output in the genesis of experimental hypertension.

NEI CHING, in his treatise, The Yellow Emperor's Classic of Internal Medicine, said "the heart is in accord with the pulse . . . the heart rules over the kidneys . . . and the blood that is stored by the heart fills the pulse with the forces of life...." With these words, 4000 years ago Nei Ching expressed his belief in the importance of the propelling force generated by the cardiac muscle in serving the metabolic requirements of the peripheral tissues. That he envisioned a major role for the heart in controlling the kidneys could be construed today as prophetic. Many investigators are now preoccupied with the possibility that the heart has an important role in the pathogenesis of arterial hypertension. This idea gained momentum with Freis's provocative review in 1960 on the hemodynamics of hypertension, 141 years after Richard Bright's lucid deduction linking structural alterations of the myocardium to diseases of the kidney. This review is directed to the analysis of hemodynamic factors in experimental hypertensive disease. Studies in both man and animals have shown that arterial hypertension of various origins and duration is accompanied by various hemodynamic abnormalities; their characteristics are: (1) increased peripheral resistance with normal to low cardiac output; (2) increased cardiac output with "normal" peripheral resistance; and (3) a transitional pattern of an early rise in cardiac output with a latter progressive increase in peripheral resistance. It seems clear that most overviews of the field come to much the same conclusion. In some patients with borderline and early essential hypertension, cardiac output is raised something of the order of 15%, but it has not been shown that such an increase will necessarily result in chronic hypertension. Cardiac output in animals has been elevated