Hypertension affects over 1.2 billion individuals worldwide and has become the most critical and expensive public health problem. Hypertension is a multifactorial disease involving environmental and genetic factors together with risk-conferring behaviors. The cause of the disease is identified in ∼10% of the cases (secondary hypertension), but in 90% of the cases no etiology is found (primary or essential hypertension). For this reason, a better understanding of the mechanisms controlling blood pressure in normal and hypertensive patients is the aim of very active experimental and clinical research. In this article, we review the importance of the renin-angiotensin-aldosterone system (RAAS) for the control of blood pressure, focusing on the evolution of the system and its critical importance for adaptation of vertebrates to a terrestrial and dry environment. The evolution of blood pressure control during the evolution of primates, hominins, and humans is discussed, together with the role of common genetic factors and the possible causes of the current hypertension pandemic in the light of evolutionary medicine.
O.D. is supported by grants from the European Community's Seventh Framework Programme (305608 EURenOmics), the Swiss National Centre of Competence in Research Kidney Control of Homeostasis (NCCR Kidney.CH) program, the Swiss National Science Foundation (310030-146490), and the Rare Disease Initiative Zurich (radiz), a clinical research priority program of the University of Zurich, Switzerland. M.B. is supported by the Swiss National Centre of Competence in Research Kidney Control of Homeostasis (NCCR Kidney.CH) and TransCure (www.nccr-transcure.ch) programs. She received support from Swiss National Science Foundation for a Special Program in University Medicine multicentric project (33CM30-124087/1; 30CM30_140331).
No conflicts of interest, financial or otherwise, are declared by the author(s).
- ©2017 Int. Union Physiol. Sci./Am. Physiol. Soc.