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Query: UMLS:C0085580 (essential hypertension)
 14,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The saralasin test was performed in 68 hypertensives. A clear-cut dependence of the test results on initial plasma-renin concentration and particular sodium balance was demonstrated. Because of this dependence the saralasin test should be performed only under constant conditions. A mild stimulation of the renin-angiotension system by salt restriction to a mean sodium excretion of 50 mmol daily and 80 mg furosemide by mouth 12 hours before the test seems best. In this way essential and renovascular hypertension could be distinguished with considerable reliability (P less than 0.001). Among patients with essential hypertension one could clearly separate those with high plasma-renin concentration from those with a normal or low one. Among patients with renovascular hypertension those with haemodynamically significant renal artery stenosis could with high probability be distinguished from those with non-effective stenosis. A positive saralasin test without testing the function of the normal contralateral kidney does not provide an indication for operation.
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PMID:[The saralasin test in the diagnosis of hypertension (author's transl)]. 43 89

1. The influence of the intact kidney on blood pressure, extracellular fluid volume (ECF, ferrocyanide space) and ECF volume distribution was studied in rats 60 days after constriction of the contralateral renal artery. 2. Renal artery constriction increased both blood pressure and ECF levels. The rise of both variables was more pronounced in rats with the contralateral kidney removed (one-kidney rats) than with the contralateral kidney intact (two-kidney rats). 3. The interstitial fluid volume increased similarly in both experimental groups, the more pronounced ECF increase in the more severly hypertensive one-kidney rats being due to increased plasma volume. In the less hypertensive two-kidney group the plasma volume was not increased significantly but correlated positively with the blood pressure levels. 4. The plasma volume/interstitial fluid volume ratio was decreased in the two-kidney group but did not differ from control values in the one-kidney group thus resembling the ECF partition reported in the hypo-and hypervolaemic type of essential hypertension, respectively. 5. It is suggested that the antihypertensive influence of the intact kidney may be partly due to its ability to escape from the sodium-retaining mechanism activated by renal artery stenosis, which determines the degree of plasma volume expansion and, in connection with this, also the degree of blood pressure elevation.
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PMID:Extracellular fluid distribution in rats with chronic one- and two-kidney Goldblatt hypertension. 49 90

The value of radiological examinations in hypertension was analyzed in a series of 44 children. An i.v. urography had been performed in 43 cases with a pathological finding in 19 (44%). Renal angiography, employed in 19 cases, revealed abnormal findings in 12 (63%) patients. Micturating urethrocystography performed in 16 children gave no additional important information. The only complication noted was thrombosis of the femoral artery subsequent to renal angiography in one child less than one year of age. The diagnosis of hypertension based mainly on the i.v. urography in 12 cases but the renal angiography gave additional important information in 6 children. One child with obstructive hydronephrosis was also found to have a renal artery stenosis at renal arteriography. Based on these results, and particularly because secondary hypertension may frequently be treated surgically, we consider extensive radiological investigation with renal angiography is mandatory before receiving a final diagnosis of essential hypertension, and before starting long-term treatment.
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PMID:The radiological evaluation of children with hypertension. 51 Mar 18

A positive saralasin test in patients with angiographic evidence of renovascular disease and other positive functional tests gives further assurance that these patients will achieve normal or substantially reduced blood pressure postoperatively. In our experience with proved renovascular hypertension there was a 19% incidence of falsely negative saralasin tests. Therefore, saralasin should not be used as the sole screening test in hypertensive patients suspected of having surgically correctable lesions. There is a direct correlation between elevated renin activity and a positive saralasin test. In some patients saralasin may be more sensitive than any other currently used test to detect overactivity of the renin-angiotensin system. This would determine those patients with technical errors in renin sampling and assays. Of the 16 patients (all normotensive) who had 6-month followup tests 5 had elevated peripheral renin activity, probably owing to furosemide stimulation. Of these 5 patients 2 had a positive postoperative saralasin test, raising the question of potential falsely positive responses in cases of essential hypertension and coincidental non-functional renal artery stenosis. Patients with high renin essential hypertension may respond to saralasin, even in the absence of renal artery lesions. A saralasin test should be done in a hospital where all specific conditions can be met and potential complications handled promptly.
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PMID:Saralasin test as a diagnostic and prognostic aid in renovascular hypertensive patients subjected to renal operation. 54 21

The prognostic value of renal vein and peripheral renin levels was analyzed in 66 patients with unilateral renal artery stenosis who underwent corrective surgery. Patient selection for operation was independent of renin results. Fifty-three percent of those with confirmed renovascular hypertension had renal vein renin ratios less than 2.0, ie, within the 95% confidence limit for the control group of 82 patients with essential hypertension. Thirty-four patients with clearly lateralizing renin data (ipsilateral:contralateral greater than or equal to 1.5 and contralateral:peripheral less than or equal to 1.3) were benefited by operation, but 23 additional patients with nonlateralizing data also benefited. No proposed scheme for renin data analysis detected more than 75% of those with renovascular hypertension. Although lateralizing renin data are highly predictive of operative benefit, nonlateralizing data do not necessarily herald operative failure and should not be dogmatically used to exclude surgical intervention.
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PMID:Predictive value of renin determinations in renal artery stenosis. 57 97

Angiotensin II was infused at rates varying from 0.1 to 10 ng/kg per minute into 49 subjects with hypertension and 26 normotensive subjects and changes in blood pressure, plasma angiotensin II, and plasma renin activity (PRA) were determined after 20 and 30 minutes at each dose. Similar dose-related increases in angiotensin II and blood pressure occurred with a threshold of 1 ng/kg per minute in the normotensive and hypertensive subjects. Whereas angiotensin II induced a significant, dose-related decrement in renin activity in the normotensive subjects, with a threshold of 1.0 ng/kg per minute, no significant change in renin activity occurred in either the normal-renin or high-renin hypertensive subjects. In a separate study, nine normotensive and six hypertensive sodium-restricted subjects were given a converting enzyme inhibitor, SQ 20881, 30 microgram/kg. Despite a significantly greater fall in blood pressure (P less than 0.006) and angiotensin II concentration (P less than 0.045) in the hypertensive subjects, they did not have a greater rise in plasma renin activity. We conclude that angiotensin II reduces renin release in normal man at infusion rates that yield plasma angiotensin II levels within the physiological range but has a strikingly reduced influence on renin release in hypertension. In high-renin hypertension due to renal artery stenosis or nephrosclerosis, renin release is presumed to be relatively autonomous because of a dominant, intrarenal mechanism. The mechanism in normal-renin essential hypertension is not clear, but the abnormality could well be related to the pathogenesis of the hypertension.
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PMID:Failure of renin suppression by angiotensin II in hypertension. 61 2

We have studied the effects of intravenous infusion of saralasin, a competitive antagonist of angiotensin II, in 27 hypertensive patients: 13 had essential hypertension, 14 had renal lesions which involved the renal artery in 9 cases. In essential hypertensives saralasin administration did not significantly lower blood pressure, even after mild salt depletion. It induced a decrease in blood pressure in 7 patients with renal abnormalities (5 with renal artery stenosis, 2 with unilateral parenchymal disease). It may be suggested that in these cases hypertension was dependent, at least partly, on the renin-angiotensin system. In agreement with other investigators, we have found a relationship between the level of plasma renin activity and the blood pressure decrease obtained by saralasin. In patients with unilateral renal artery stenosis, blood pressure decrease was related to renal vein ratio of plasma renin activity.
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PMID:[Clinical usefulness of saralasin in human hypertension (author's transl)]. 64 79

In about 15% of cases hypertension is caused by renal diseases, including unilateral and bilateral parenchymatous nephropathies, renal artery stenosis and renin producing tumors. Important pathogenic determinants are the sodium volume status and the renin angiotensin system. The level of the blood pressure may also depend on the duration of hypertension. An increase in peripheral resistance plays a more important role than an increase in cardiac index. Simultaneous determination of the renin activity in both renal veins is of decisive importance in the diagnosis of renal artery stenosis. Drug treatment of renal hypertension is not essentially different from that of essential hypertension. Surgical procedures include revascularization, uninephrectomy and, in uncontrollable hemodialysis patients, binephrectomy.
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PMID:[Renal hypertension]. 79 75

In a Zurich outpatient clinic in 1975 hypertension was found in 10.4% of 8228 patients (3657 females and 4571 males). Essential (primary) hypertension was found in 92.9% of all hypertensives. Among secondary forms of hypertension (7.1%) renal hypertension was the most common (5.8%) with 4.9% for hypertension of renal parenchymatous origin, .8% renovascular hypertension, and .1% hypertension associated with unilateral hydronephrosis. In 2 patients (.2%) the underlying disease was primary aldosteronism and in 5 (.6%) coarctation of the aorta. In 4 females (.5%) hypertension was caused by oral contraceptives. Patients with essential hypertension had higher body weight than those with normal blood pressure. These differences were statistically significant in young and middle-aged patients. The percentage of primary hypertension was significantly high. In only 18 (2.1%) of 854 hypertensives was a curable form of high blood pressure found (hypertension caused by renal artery stenosis, hydronephrosis, aldosterone-producing adenoma of the adrenal gland, and oral contraceptives). The very low percentage of curable forms of high blood pressure should be kept in mind when deciding on expensive procedures in a search for secondary forms of high blood pressure.
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PMID:[Primary and secondary hypertension in polyclinical patients]. 85 17

Saralasin, an angiotensin II antagonist, was infused into 49 patients with renal artery stenosis, 10 patients with essential hypertension and normal renal arteriograms, and five patients with "low-renin essential hypertension." Renal venous renin and differential renal function studies were used to assess the functional significance of arterial stenoses. "Response" to saralasin, evidenced by a fall in blood pressure during infusion, occurred in no patients with "low renin" hypertension and in only 20% of patients with normal renal arteriograms. In contrast, saralasin "response" occurred in more than 80% of patients with renal artery stenosis and lateralizing functional studies and 100% of cases of "proven" renovascular hypertension (cure or improvement of hypertension after operative treatment). We suggest that saralasin infusion might be a valuable screening test for the recognition of renovascular hypertension.
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PMID:Saralasin infusion in the recognition of renovascular hypertension. 87 17


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