Document Detail


Does the renin-angiotensin system determine the renal and systemic hemodynamic response to sodium in patients with essential hypertension?
MedLine Citation:
PMID:  8567042     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Many patients with essential hypertension respond to a high dietary sodium intake with a rise in blood pressure. Experimental evidence suggests that the renal hemodynamic response to sodium determines, at least partially, this rise in blood pressure. Our aim was to clarify the role of the renin-angiotensin system in the renal and systemic adaptation to a change in dietary sodium. We studied changes in mean arterial pressure (MAP) (millimeters of mercury), effective renal plasma flow (ERPF), body weight, and immunoreactive renin in 17 patients with essential hypertension and 15 normotensive control subjects, randomly crossing over between a 3-week sodium-restricted (50 mmol/24 h) and a sodium-replete (200 mmol/24 h) diet period. In addition, the effects of renin inhibition by remikiren (600 mg, single oral dose) were studied during the high sodium period. In normotensive control subjects, high sodium intake had no effect on MAP or body weight, whereas ERPF increased (490 +/- 19 to 535 +/- 21 mL/min, P < .05) and immunoreactive renin decreased (32 +/- 6 to 14 +/- 1 pg/mL). In hypertensive subjects, high sodium intake induced a heterogeneous response of MAP (median change, 2.6 mm Hg; range, -4.7 to +21.2; P = NS) and ERPF (median change, 21 mL/min; range, -33 to +98; P = NS). Body weight increased from 81.3 +/- 1.9 to 82.5 +/- 2.0 kg (P < .05), and immunoreactive renin decreased from 18 +/- 3 to 10 +/- 1 pg/mL (P < .05). Interestingly, the patients with a distinct rise in MAP showed a blunted ERPF response to high sodium intake (r = -.70, P < .01) and an increase in body weight (r = .76, P < .001). Moreover, the increase of ERPF was more pronounced in patients with a larger fall in immunoreactive renin (r = .77, P < .001). After administration of remikiren, a heterogeneous response in ERPF was observed: the patients with the blunted ERPF response to high sodium intake showed the largest ERPF rise (r = .70, P < .01). The remikiren-induced rise in ERPF correlated (r = .68, P < .01) with the fall in MAP (114 +/- 2 to 110 +/- 2 mm Hg). In conclusion, in patients with essential hypertension a rise in blood pressure in response to high sodium intake appears to partially be the result of insufficient renal vasodilatation. This seems to be due to an inadequate (intrarenal?) renin-angiotensin system response to increased sodium intake.
Authors:
P van Paassen; D de Zeeuw; G Navis; P E de Jong
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Hypertension     Volume:  27     ISSN:  0194-911X     ISO Abbreviation:  Hypertension     Publication Date:  1996 Feb 
Date Detail:
Created Date:  1996-03-06     Completed Date:  1996-03-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  202-8     Citation Subset:  IM    
Affiliation:
Groningen Institute for Drug Studies (of Gronigen Utrecht Institute for Drug Exploration), Department of Medicine, State University Hospital, Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antihypertensive Agents / pharmacology
Blood Pressure* / drug effects
Cross-Over Studies
Diet, Sodium-Restricted*
Female
Hemodynamics* / drug effects
Humans
Hypertension / physiopathology*
Imidazoles / pharmacology
Male
Middle Aged
Reference Values
Regional Blood Flow / drug effects
Regression Analysis
Renal Circulation* / drug effects
Renin / antagonists & inhibitors,  blood
Renin-Angiotensin System*
Sodium, Dietary / pharmacology*
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Imidazoles; 0/Sodium, Dietary; 135669-48-6/remikiren; EC 3.4.23.15/Renin
Comments/Corrections
Comment In:
Hypertension. 1996 Dec;28(6):1102-3   [PMID:  8952605 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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