The Evolution of Hypertension: old genes, new concepts

Morag K. Mansley, Jessica R. Ivy, Matthew A. Bailey

Research output: Contribution to journalArticlepeer-review


Hypertension is the silent killer driving the global public health burden of cardiovascular and
renal disease. Blood pressure homeostasis is intimately associated with sodium balance and
the distribution of sodium between fluid compartments and within tissues. On a population
level, most societies consume 10 times more salt that the 0.5g required by physiological need.
This high salt intake is strongly linked to hypertension and The World Health Organization
targeting a ~30% relative reduction in mean population salt intake to arrest the global
mortality due to cardiovascular disease. But how does a habitually high salt diet cause blood
pressure to rise? In this focussed review, we discuss two “Evolutionary Medicine” concepts,
presented at the ISN Forefront Meeting “Immunomodulation of Cardio-renal Function”. We
first examine how ancestral variants in genes conferring a selection advantage during early
human development are now maladaptive. We then discuss the conservation of “renal”
sodium transport processes across multiple organ systems, including the brain. These systems
influence sodium appetite and can exert an often overlooked effect on long-term blood
pressure control.
Original languageEnglish
JournalKidney International
Early online date6 Aug 2016
Publication statusPublished - Sep 2016


  • blood pressure, hypertension, evolution, kidney, salt, inflammation, ressure natriuresis


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