Hypertension as Related to Renal Ischemia: The George E. Brown Memorial Lecture

IT WAS a most unexpected pleasure to receive your invitation to join the distinguished group of men who have previously honored Dr. George E. Brown in this lectureship. From a review of Dr. Brown's extensive bibliography and some of the obituary editorials folloving his death,1-3 it seems clear why Dr. Woodyatt described him as "an unusual man with an unusual story."4 Dr. Brown made himself highly expert in what was then known of renal physiology and the heinous effects of high blood pressure. But it was pure chance, as you will see, that led to your speaker's interest in a curable type of hypertension. In so enigmatic a disorder it behooves us to study with great care those few types that are subject to permanent correction. At this time and before such an audience, there is no need to belabor the point that ischemia * of a kidney can, in man, result in high blood pressure. There are many well-documented instances of such occurrence, with complete and lasting restoration to normotension following nephrectomy or plastic vascular surgery, which is after all the only proof that renal ischemia was causative. But how does one discern with precision the presence of such surgically correctable situations and hence benefit the few without subjecting many to needless and unrewarding operations? How ischemic must a kidney be to result in hypertension? How long can such a kidney remain ischemic and still be susceptible to functional