Evolutionary medicine: The hypertension pandemic

This presentation was given by Bernard Rossier, Emeritus Professor at the Department of Pharmacology and Toxicology at University of Lausanne, Switzerland. It was presented as Keynote Speech at the ISN’s Forefronts Symposium 2015 taking place in Shenzhen, China, on October 22-25, 2015 for which the theme was ‘Immunomodulation of Cardio-Renal Function’.

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Presentation Abstract:

Hypertension is the most common disease in the human population, affecting over 1 billion individuals worldwide, and is one of the major treatable risk factors in cardiovascular diseases including stroke, myocardial infarction, heart and kidney failure. Despite the importance of hypertension as a cause of cardiovascular-renal disease, its pathogenesis is largely unknown. A large number of physiological, pharmacological, genetic and clinical evidence have, however, verified Guyton’s 30-year old hypothesis stating that blood pressure is critically dependent on salt handling by the kidney (2).
In this lecture I will emphasize the critical role of the renin-angiotensin-aldosterone-system (RAAS) in salt conservation during the evolution of vertebrates and in the control of blood pressure (1). I will focus on the importance of genetic and environmental factors to explain the variability of the blood pressure trait. I will finally discuss the gene-culture-environment mismatch hypothesis as origin of the hypertension pandemic and why evolutionary medicine is an emerging field with a great potential for the identification of novel diagnostic tests, drug targets and therapies (1).

1. Rossier BC, Baker ME, and Studer RA. Epithelial sodium transport and its control by aldosterone: the story of our internal environment revisited. Physiol Rev 95: 297-340, 2015.
2. Rossier BC, Staub O, and Hummler E. Genetic dissection of sodium and potassium transport along the aldosterone-sensitive distal nephron: importance in the control of blood pressure and hypertension. FEBS letters 587: 1929-1941, 2013.