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      Mechanism of herbal medicine on hypertensive nephropathy

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          Abstract

          Hypertensive nephropathy is the most common complication of hypertension, and is one of the main causes of end-stage renal disease (ESRD) in numerous countries. The basic pathological feature of hypertensive nephropathy is arteriolosclerosis followed by renal parenchymal damage. The etiology of this disease is complex, and its pathogenesis is mainly associated with renal hemodynamic changes and vascular remodeling. Despite the increased knowledge on the pathogenesis of hypertensive nephropathy, the current clinical treatment methods are still not effective in preventing the development of the disease to ESRD. Herbal medicine, which is used to relieve symptoms, can improve hypertensive nephropathy through multiple targets. Since there are few clinical studies on the treatment of hypertensive nephropathy with herbal medicine, this article aims to review the progress on the basic research on the treatment of hypertensive nephropathy with herbal medicine, including regulation of the renin angiotensin system, inhibition of sympathetic excitation, antioxidant stress and anti-inflammatory protection of endothelial cells, and improvement of obesity-associated factors. Herbal medicine with different components plays a synergistic and multi-target role in the treatment of hypertensive nephropathy. The description of the mechanism of herbal medicine in the treatment of hypertensive nephropathy will contribute towards the progress of modern medicine.

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          Most cited references132

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          Obesity, kidney dysfunction and hypertension: mechanistic links

          Excessive adiposity raises blood pressure and accounts for 65–75% of primary hypertension, which is a major driver of cardiovascular and kidney diseases. In obesity, abnormal kidney function and associated increases in tubular sodium reabsorption initiate hypertension, which is often mild before the development of target organ injury. Factors that contribute to increased sodium reabsorption in obesity include kidney compression by visceral, perirenal and renal sinus fat; increased renal sympathetic nerve activity (RSNA); increased levels of anti-natriuretic hormones, such as angiotensin II and aldosterone; and adipokines, particularly leptin. The renal and neurohormonal pathways of obesity and hypertension are intertwined. For example, leptin increases RSNA by stimulating the central nervous system proopiomelanocortin-melanocortin 4 receptor pathway, and kidney compression and RSNA contribute to renin-angiotensin-aldosterone system activation. Glucocorticoids and/or oxidative stress may also contribute to mineralocorticoid receptor activation in obesity. Prolonged obesity and progressive renal injury often lead to the development of treatment-resistant hypertension. Patient management therefore often requires multiple antihypertensive drugs and concurrent treatment of dyslipidaemia, insulin resistance, diabetes and inflammation. If more effective strategies for the prevention and control of obesity are not developed, cardiorenal, metabolic and other obesity-associated diseases could overwhelm health-care systems in the future.
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            Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis.

            Recent hypertension guidelines have reversed previous recommendations for lower blood pressure targets in high-risk patients, such as those with cardiovascular disease, renal disease, or diabetes. This change represents uncertainty about whether more intensive blood pressure-lowering strategies are associated with greater reductions in risk of major cardiovascular and renal events. We aimed to assess the efficacy and safety of intensive blood pressure-lowering strategies.
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              The structural factor of hypertension: large and small artery alterations.

              Pathophysiological studies have extensively investigated the structural factor in hypertension, including large and small artery remodeling and functional changes. Here, we review the recent literature on the alterations in small and large arteries in hypertension. We discuss the possible mechanisms underlying these abnormalities and we explain how they accompany and often precede hypertension. Finally, we propose an integrated pathophysiological approach to better understand how the cross-talk between large and small artery changes interacts in pressure wave transmission, exaggerates cardiac, brain and kidney damage, and lead to cardiovascular and renal complications. We focus on patients with essential hypertension because this is the most prevalent form of hypertension, and describe other forms of hypertension only for contrasting their characteristics with those of uncomplicated essential hypertension.
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                Author and article information

                Journal
                Mol Med Rep
                Mol Med Rep
                Molecular Medicine Reports
                D.A. Spandidos
                1791-2997
                1791-3004
                April 2021
                26 January 2021
                26 January 2021
                : 23
                : 4
                : 234
                Affiliations
                [1 ]Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P.R. China
                [2 ]Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, P.R. China
                [3 ]Shunyi Branch, Beijing Traditional Chinese Medicine Hospital, Beijing 101300, P.R. China
                [4 ]Beijing Chinese Medicine Hospital Pinggu Hospital, Beijing 101200, P.R. China
                [5 ]Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, P.R. China
                Author notes
                Correspondence to: Dr Baoli Liu, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng, Beijing 100010, P.R. China, E-mail: liubaoli@ 123456bjzhongyi.com
                Article
                MMR-0-0-11873
                10.3892/mmr.2021.11873
                7893801
                33537809
                414fb7fe-dcee-41df-86d9-28a868405608
                Copyright: © Dong et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 02 September 2020
                : 30 December 2020
                Funding
                Funded by: National Key Research and Development Project
                Award ID: 2019YFC1709402
                Funded by: National Natural Science Foundation of China, open-funder-registry 10.13039/501100001809;
                Award ID: 81673907
                Award ID: 81973793
                Funded by: Natural Science Foundation of Beijing Municipality, open-funder-registry 10.13039/501100004826;
                Award ID: 7182070
                Funded by: Beijing Municipal Administration of Hospitals Clinical Medicine Development
                Award ID: XLMX201833
                This study was supported by grants from the National Key Research and Development Project (grant no. 2019YFC1709402), National Natural Science Foundation of China (grant nos. 81673907 and 81973793 awarded to LB), Natural Science Foundation of Beijing Municipality (grant no. 7182070 awarded to LB) and Beijing Municipal Administration of Hospitals Clinical Medicine Development of special funding support (grant no. XLMX201833 awarded to LB).
                Categories
                Review

                hypertensive nephropathy,herbal medicine,vascular remodeling,endothelial cells,renin angiotensin system

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