Malignant hypertension - the role of the paracrine renin-angiotensin system

Malignant hypertension remains one of the life-threatening complications of blood pressure elevation. It is a clinico-pathological syndrome of severe blood pressure elevation combined with malignant vascular injury. This is a characteristic form of vascular damage,,vith two elements: fibrinoid necro sis and endarteritis proliferans. Although the morphology of these has been well described, the molecular events are not fully understood. This review summarizes the evidence from transgenic animals for a role for the activat ion of a local paracrine renin-angiotensin system in the pathogenesis of ma lignant vascular injury. These animal models provide pathological, pharmaco logical, and genetic evidence supporting the hypothesis that intra-renal ge neration of angiotensin 2 and exposure of the microcirculation to elevated blood pressure cooperate in causing tissue damage in malignant hypertension . Copyright (C) 2000 John Wiley & Sons, Ltd.