Hypertension : High Blood Pressure

Could This Be Another Paill Spectrum Capacity Disease

Strangely there are many diseases in modern medicine where there appears to be no known cause.  Doctors usually describe these as having an idiopathic cause.

 

How Might Paill Spectrum
Affect Blood Pressure? 

The answer lies in the effects of the sympathetic nerves on the body’s organs.  Normally, adrenergic hormones / the action of the sympathetic nervous system diverts blood from organs to the muscles, in preparation for the fight or flight responses.  However in Paill Spectrum, this action results in prolonged vascular constriction of the glomerular arterioles of the kidney.  When the afferent arteriole of the glomerulus is constricted for long periods of time, the blood flow deficiency affects the more sensitive parts of the glomerular / tubular structure.

There is another subgroup of patients who have puzzled me.  There are a number of patients who inexplicably develop renal deterioration with rising creatinine (though often still within normal limits). 

The Paill Spectrum Model would propose that both these people represent other subgroups of Paill Spectrum.  In these patients, the sympathetically mediated afferent arteriolar vasoconstriction reduces glomerular blood flow and reduces the flow of blood to the renal medulla. 

Not every patient has every Paill Spectrum symptom.  So of course, if the particular sympathetic nerves are not affected in each individual patient, there will of course be no symptoms. Renal diseases are “capacity” diseases.  Problems develop only when the capacity of the specific organ to function normally, is compromised.

The Paill Spectrum model would propose that there are two adaptations to Paill Spectrum vasoconstrictive effects on the kidneys. Back to Hypertension Top

• In the first case, the body increases pressure which overcomes Paill Spectrum initiated sympathetic afferent arteriolar constriction. This maintains perfusion of the renal tissues and renal function is preserved though blood pressure of course rises and begins to need treatment before injury is caused to other body systems.
  
  
• In the second case group, the body fails to adapt to the Paill Spectrum initiated sympathetic afferent arteriolar constriction by raising blood pressure. Consequently renal blood flow falls. These patients develop a gradual deterioration of renal function over years. Once sufficient renal function is lost, renal perfusion is maintained by the need to distribute renal arteriolar blood across a smaller group of surviving nephrons resulting in stabilisation of the renal function deterioration at higher (creatinine) levels than previously, but usually still within the normal reference range for (creatinine and urea) renal function measuring tests.

Hypertension where related to Paill Spectrum itself appears to be a reflex issue, Patients with the most sympathetic activation  (probably LIR variant Paill Spectrum patients), would be expected to develop the most severe forms of damage.

The Paill Spectrum model would predict that in early cases with Paill Spectrum related hypertension, blood pressure could be stabilised with treatment.  Alternately, if patients stayed on blood pressure medication, it may be expected that their blood pressure would become more responsive to therapy or easier to treat. Blood pressure fluctuations of instability would be predicted to be an early marker for the presence of Paill Spectrum renal damage. Many of these patients would over a number of years progress to develop frank hypertension.

The Paill Spectrum model would propose that Paill Spectrum may have a role in the genesis of hypertension through neurally mediated sympathetic mechanisms.  The sympathetic nervous system is the predominant vehicle by which Paill Spectrum causes its effects in the body, outside of the central nervous system. Back to Hypertension Top

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