Abstract

To understand blood pressure is regulated, and how this regulation is disturbed in hypertension, we need to understand how blood volume is regulated and how the distribution of that volume across the vascular tree is regulated. Here we review the literature on blood volume regulation and how it is disturbed in the pre-diabetic and diabetic state. We also provide a comprehensive overview of vascular dysfunction, discussing the key mechanisms, mediators and pathways which are involved. In particular, we focus on the key concept of endothelial dysfunction and how this has shaped our understanding of hypertension.

Keywords: Metabolic syndrome, diabetes, hypertension, obesity, insulin resistance, volume homeostasis, endothelial dysfunction, kidney, sympathetic nervous system, renin-angiotensin system