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Review
. 2021 Apr 2;128(7):847-863.
doi: 10.1161/CIRCRESAHA.121.318082. Epub 2021 Apr 1.

Pathophysiology of Hypertension: The Mosaic Theory and Beyond

David G Harrison  1 , Thomas M Coffman  2 , Christopher S Wilcox  3
Affiliations
Review

Pathophysiology of Hypertension: The Mosaic Theory and Beyond

David G Harrison et al. Circ Res. .

Abstract

Dr Irvine Page proposed the Mosaic Theory of Hypertension in the 1940s advocating that hypertension is the result of many factors that interact to raise blood pressure and cause end-organ damage. Over the years, Dr Page modified his paradigm, and new concepts regarding oxidative stress, inflammation, genetics, sodium homeostasis, and the microbiome have arisen that allow further refinements of the Mosaic Theory. A constant feature of this approach to understanding hypertension is that the various nodes are interdependent and that these almost certainly vary between experimental models and between individuals with hypertension. This review discusses these new concepts and provides an introduction to other reviews in this compendium of Circulation Research.

Keywords: blood pressure; history; hypertension; inflammation; reactive oxygen species.

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Conflict of interest statement

Disclosures: The authors have no conflicts of interest relevant to this manuscript.

Figures

Figure 1:
Figure 1:
The original (A) and revised (B) Mosaic Theories proposed by Page.
Figure 2:
Figure 2:
Perturbations of the kidney (A), vasculature (B) and central nervous system (C) contributing to hypertension.
Figure 3:
Figure 3:
A revised Mosaic Theory incorporating new understanding of cellular, environmental and genetic mechanisms.
See this image and copyright information in PMC

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