The evolution of blood pressure and the rise of mankind

Nephrol Dial Transplant. 2015 May;30(5):713-23. doi: 10.1093/ndt/gfu275. Epub 2014 Aug 18.


Why is it that only human beings continuously perform acts of heroism? Looking back at our evolutionary history can offer us some potentially useful insight. This review highlights some of the major steps in our evolution-more specifically, the evolution of high blood pressure. When we were fish, the first kidney was developed to create a standardized internal 'milieu' preserving the primordial sea within us. When we conquered land as amphibians, the evolution of the lung required a low systemic blood pressure, which explains why early land vertebrates (amphibians, reptiles) are such low performers. Gaining independence from water required the evolution of an impermeable skin and a water-retaining kidney. The latter was accomplished twice with two different solutions in the two major branches of vertebrate evolution: mammals excrete nitrogenous waste products as urea, which can be utilized by the kidney as an osmotic agent to produce more concentrated urine. Dinosaurs and birds have a distinct nitrogen metabolism and excrete nitrogen as water-insoluble uric acid-therefore, their kidneys cannot use urea to concentrate as well. Instead, some birds have developed the capability to reabsorb water from their cloacae. The convergent development of a separate small circulation of the lung in mammals and birds allowed for the evolution of 'high blood-pressure animals' with better capillarization of the peripheral tissues allowing high endurance performance. Finally, we investigate why mankind outperforms any other mammal on earth and why, to this day, we continue to perform acts of heroism on our eternal quest for personal bliss.

Keywords: blood pressure; evolution; kidney.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Amphibians
  • Animals
  • Biological Evolution*
  • Birds
  • Blood Pressure / physiology*
  • Fishes / physiology
  • Humans
  • Kidney / metabolism
  • Kidney / physiology*
  • Lung / physiology
  • Mammals
  • Reptiles
  • Urea / metabolism
  • Uric Acid / metabolism
  • Vertebrates


  • Uric Acid
  • Urea