The obligatory role of the kidney in long‐term arterial blood pressure control: extending Guyton’s model of the circulation

Summary We describe a model for the essential role of the kidney in long‐term blood pressure regulation. We begin with a simple hydraulic model for the circulation, with a constant circulating volume. We show, with the help of a modification of Guyton’s classic diagram, that cardiac output and mean arterial pressure are functions of circulating volume, peripheral resistance, venous and arterial compliances, and the cardiac Starling curve. This approach models only acute changes in a ‘closed’ circulation – one where there is no intake or excretion of fluid. The model is then adapted to ‘open’ the circulation, include a role for the kidney, and represent more chronic changes. Arterial pressure is then a sole function of renal behaviour and daily sodium (and liquid) intake, and becomes independent of other cardiovascular variables. As well as generating specific hypotheses for further investigation, these models can be used for the purpose of education in cardiovascular control and the treatment of hypertension.