Angiotensin II and atrial natriuretic peptide — unity and struggle of opposites in the model of renovascular hypertension “2 kidneys, 1 clamp”: A meta-analysis

Abstract

Background. Today, the Goldblatt model of hypertension “2 kidneys, 1 clamp” has been investigated in a large number of experimental studies. The activation of the renin-angiotensin system (RAS) underlies the development of this type of hypertension. The main buffer of the RAS is the atrial natriuretic peptide (ANP), its level is significantly increased in response to blood pressure (BP) elevation and high concentration of angiotensin II and Na+. ANP has a pronounced hypotensive effect. Clinical and experimental studies show that unilateral renovascular hypertension (URH) does not always develop even in significant stenosis of the renal artery. The purpose of this work is to investigate the activity of the RAS and the ANP, shifts in the water-electrolyte balance and renal sympathetic nervous activity via meta-analysis, to evaluate hypertensive and hypotensive mechanisms in the model of renovascular hypertension “2 kidneys, 1 clamp”. Design and methods. The meta-analysis was carried out by statistical program Review Manager 5.3 (Cochrane Library). In a meta-analysis, we used 76 publications of experimental studies of the model of renovascular hypertension in rats. Results and conclusions. The meta-analysis showed that the maintenance of URH is ensured by the high activity of the RAS and the sympathetic nervous system, as well as hypokalemia and cardiovascular remodeling. However. there is no convincing evidence of the effect of sodium-volume-dependent mechanisms on BP elevation in this model of hypertension.