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Renal angiotensin-converting enzyme and blood pressure control

Bernstein, Kenneth E.; Giani, Jorge F.; Shen, Xiao Z.; Gonzalez-Villalobos, Romer A.

Current Opinion in Nephrology & Hypertension: March 2014 - Volume 23 - Issue 2 - p 106–112
doi: 10.1097/01.mnh.0000441047.13912.56
PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown

Purpose of review: This review presents novel findings regarding the renal angiotensin-converting enzyme (ACE) and its role in blood pressure (BP) control.

Recent findings: The textbook flow diagram of the renin–angiotensin system (RAS) shows the pulmonary endothelium as the main source of the ACE that converts angiotensin I to angiotensin II. However, ACE is made in large quantities by the kidneys, which raises the important question of what precisely is the function of renal ACE? Recent studies in gene-targeted mice indicates that renal ACE plays a dominant role in regulating the response of the kidney to experimental hypertension. In particular, renal ACE and locally generated angiotensin II affect the activity of several key sodium transporters and the induction of sodium and water retention resulting in the elevation of BP.

Summary: New experimental data link the renal ACE/angiotensin II pathway and the local regulation of sodium transport as key elements in the development of hypertension.

Departments of Biomedical Sciences and Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

Correspondence to Ken E. Bernstein, MD, Cedars-Sinai Medical Center, Davis 2021, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Tel: +1 310 423 7562; fax: +1 310 423 7331; e-mail: kbernst@cshs.org and Romer A. Gonzalez-Villalobos, MD, PhD, Tel: +1 310 423 0551; fax: +1 310 423 7331; e-mail: romer.gonzalez@csmc.edu

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