The prevalence of hypertension, which is predicted to be the leading global cause of death and disability by the year 2020, increases with age from less than 10% of US adults aged 18-39 to more than 65% of US adults above the age of 60. Significantly, less than half of elderly patients with hypertension achieve adequate blood pressure control. The development of antihypertensive drugs has been dramatically less productive than expected, making new mechanistic insights into blood pressure regulation essential. This application will test the global hypothesis that attenuated mechanosensitive afferent renal nerve sympathoinhibitory reno-renal reflexes evoke sodium chloride cotransporter-mediated renal sodium retention and age-dependent hypertension. These studies will employ our novel technique of selective afferent renal nerve ablation, a unique in-vivo surgical approach to activate the mechanosensitive afferent renal nerves and genetic and pharmacological tools in 3, 8 and 16 month old Sprague-Dawley rats (model of normal aging) that exhibit age- dependent hypertension to provide new mechanistic insight into the pathophysiology of age-dependent hypertension. The following Specific Aims will be conducted to test this hypothesis:
Specific Aim 1 : Age- dependent impairments in the sensory afferent renal nerves contribute to age-dependent hypertension.
Specific Aim 2 : Attenuation of the mechanoreceptor-activated sympathoinhibitory afferent renal nerve natriuretic reno-renal reflex occurs in age-dependent hypertension.
Specific Aim 3 : Age-dependent elevations in sympathetic tone increase NCC activity, via a NE-?1-adrenoceptor-gated WNK1-OxSR1 signal transduction pathway, to evoke renal nerve-dependent sodium retention and hypertension. These hypertension focused studies are central to the missions of the NHLBI, which is to promote the prevention and treatment of heart, lung and blood disease, and the NIA, which is to understand the nature of the aging proves and diseases associated with aging to extend healthy years of life.
Specific Aim 1 will establish an age-dependent role of the afferent renal nerves in sodium excretion, sympathetic outflow and blood pressure regulation during acute and chronic challenges to salt and water balance.
Specific Aim 2 will establish a central role of an impairment in renal mechanoreceptor activation in the pathophysiology of age-dependent hypertension.
Specific Aim 3 will establish the age-dependent actions of the sympathetic nervous system to regulate the sodium chloride cotransporter, via a novel ?1- adrenoceptor signal transduction pathway. Our innovative research strategy will define a novel age-dependent afferent renal nerve mechanism through which the sympathetic nervous system regulates sodium excretion and blood pressure, and will potentially identify new therapeutic targets and/or personalized treatment paradigms for sympathetically mediated age-dependent hypertension.
The prevalence of hypertension, which is predicted to be the leading global cause of death and disability by 2020, increases with age from <10% of U.S. adults aged 18-39 to >65% of U.S. adults above age 60, and the risk of hypertension-related mortality increases dramatically with age. This project will establish the mechanisms that operate between the sympathetic nervous system and the kidney to regulate long-term sympathetic outflow, sodium homeostasis, and blood pressure in age-dependent hypertension in a model of normal aging, the Sprague Dawley rat. Our research strategy will define an age-dependent afferent renal nerve mechanism through which the sympathetic nervous system regulates sodium excretion and blood pressure, and will potentially identify new therapeutic targets and/or personalized treatment paradigms for age- dependent hypertension.
