Table 1.

Evidence supporting flow against pressure as the causative factor of common hypertensive complications

	Against pressure as the dominant factor	For flow as the dominant factor
Pressure changes whereas organ flow is constant
Hydrostatic pressure
Effects of gravity	Involvement of the brain (the lowest pressure)	Involvement of organs with higher flow
Positional change	No effect of HSP	Target organ flow is unchanged
No gravity	No effect of HSP	Target organ flow is unchanged
High BP in physiologic conditions
Exercise	No effect of exercise induced BP increase	Target organ flow is unchanged
Comparative physiology	No effect of HT in the giraffe	Target organ flow is unchanged (?)
Pressure is constant whereas organ flow may be changing
Hemodynamic studies	Vascular changes predating increase in BP	Increased flow as the possible earliest finding
Residual risk	Arbitrary definition of HT
Resistant hypertension	Natural BP > treated BP for the same level
	Significant residual risk in treated HT
	Resistance to treatment > achieved BP level
Other
Type of damage	Less directly pressure-related complications	Dominance of endothelial complications

BP - blood pressure; HSP - hydrostatic pressure; >, better or more important