Document Detail

The renin-aldosterone response to stimulation and suppression during normal pregnancy.
MedLine Citation:
PMID:  16036386     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: During normal pregnancy, studies have shown increased activity of the renin-angiotensin-aldosterone system (RAAS) and a dissociation of plasma renin activity (PRA) and aldosterone (Aldo) evidenced by a greater increase in Aldo relative to PRA. The aims of this study were to examine the RAAS response to stimulation by upright posture and suppression by saline infusion and to investigate the PRA-Aldo dissociation under these two conditions.
METHODS: We studied 24 healthy normotensive women (mean+/-standard error of mean, ages 29+/-1 yrs) in sodium (Na) balance in the second and third trimesters and postpartum. Subjects underwent a 24-hour urine collection which was analyzed for Na, norepinephrine (NE), epinephrine (Epi), and dopamine (DA); a posture study with analysis of blood pressure (BP), PRA, Aldo, NE, Epi, DA, and cortisol; and a 0.9% NaCl infusion study (500 mL/hr for 3 hrs) with analysis of BP, PRA, Aldo, cortisol, and digitalis-like factor (DLF). Analyses included paired t tests to compare posture and saline responses, repeated measures to compare across periods, and percent change to evaluate the PRA-Aldo dissociation.
RESULTS: During pregnancy, PRA, Aldo, BP, catecholamines, and cortisol levels were significantly greater in upright than left lateral decubitus (LLD) posture, and the percent change in Aldo was significantly greater than the percent change in PRA. During pregnancy in response to saline infusion, BP did not change; the PRA and Aldo significantly decreased; the percent change in Aldo was significantly greater than the percent change in PRA in the second trimester; and serum DLF and cortisol levels significantly decreased.
CONCLUSIONS: In longitudinally studied normal pregnancy, PRA and Aldo levels were dissociated at baseline, with stimulation and, to a lesser degree, with suppression. Norepinephrine, adrenocorticotrophic hormone, and DLF may contribute to this dissociation, and clarification of these interactions may provide insight into the regulation of aldosterone during normal and hypertensive pregnancy.
Rhonda Bentley-Lewis; Steven W Graves; Ellen W Seely
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Hypertension in pregnancy     Volume:  24     ISSN:  1064-1955     ISO Abbreviation:  Hypertens Pregnancy     Publication Date:  2005  
Date Detail:
Created Date:  2005-07-22     Completed Date:  2005-08-30     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  9421297     Medline TA:  Hypertens Pregnancy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1-16     Citation Subset:  IM    
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MeSH Terms
Aldosterone / metabolism*,  urine
Blood Pressure Determination
Cohort Studies
Linear Models
Longitudinal Studies
Postpartum Period / metabolism,  urine
Pregnancy / drug effects,  physiology*
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Prenatal Care
Reference Values
Renin / metabolism*,  urine
Renin-Angiotensin System / drug effects*,  physiology*
Sodium Chloride / administration & dosage*
Water-Electrolyte Balance
Grant Support
2 P50 HL 55000-06/HL/NHLBI NIH HHS; 5 MO1 RR02635/RR/NCRR NIH HHS; K24 RR018613-01/RR/NCRR NIH HHS; L32 MD001077/MD/NIMHD NIH HHS; L32 MD001077-01/MD/NIMHD NIH HHS; R01 HL67332-01/HL/NHLBI NIH HHS
Reg. No./Substance:
4964P6T9RB/Aldosterone; 7647-14-5/Sodium Chloride; EC

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

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