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

To investigate the role of the renin-angiotensin-aldosterone system as a cause of hypertension, 20 hypertensive patients with coarctation of the aorta were studied during normal and low sodium intake and after diuresis with flurosemide. Eight patients with essential hypertension and 13 control subjects were similarly studied. Plasma renin activity values in patients with coarctation were similar to those in patients with essential hypertension and in control patients during normal and low sodium diets. However, after the administration of furosemide, plasma renin activity values were significantly higher in the patients with coarctation than in the other two groups (P less than 0.005 and less than 0.01, respectively). The values for urinary aldosterone, plasma volume and extracell fluid volume (bromide space) were increased in patients with coarctation during both normal and low sodium intake. These renin and aldosterone responses and body fluid spaces in patients with coarctation suggest that their hypertension resembles a one-kidney Goldblatt model. The data help to better define the role of the renin-angiotensin-aldosterone system in the hypertension of coarctation and thus may help guide the clinician in therapeutic interventions.
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PMID:Role of the renin-angiotensin-aldosterone system in hypertensive children with coarctation of the aorta. 42 21

Altered erythrocyte Na+ transport has been observed in relation to the pathogenesis of essential hypertension. In the present study, intracellular Na+ and K+ levels, Na(+)-K+ pump activity, Na(+)-K+ cotransport, and Na+ passive permeability were measured in erythrocytes of DOC-salt hypertensive (DSH) rats, two-kidney, one clip Goldblatt hypertensive (2KH) rats, and spontaneously hypertensive rats (SHR). The results were as follows: 1. In comparison with the control groups, no change in the erythrocyte Na+ level was noted in the DSH and 2KH groups, whereas a significant increase was seen in the SHR group. 2. Although no change was noted in the erythrocyte K+ level in the 2KH and SHR groups when compared with the control groups, a significant decrease was seen in the DSH group. 3. Na(+)-K+ pump activity of erythrocytes was not changed in the DSH and 2KH groups when compared with the control group, but a significant increase was noted in the SHR group. 4. Na(+)-K+ cotransport of erythrocytes was not changed in any hypertensive rats when compared with the controls. 5. Na+ passive permeability in the erythrocyte membrane was not changed in the DSH and 2KH groups when compared with the control groups, but a significant increase was noted in the SHR group. These findings suggest that increased erythrocyte Na+ levels in SHR are due to increased Na+ passive permeability of the erythrocyte membrane, and increased Na(+)-K+ pump activity may be compensating for the increased intracellular Na+ concentration in erythrocytes. Furthermore, the increase in Na+ passive permeability observed in SHR might not result from hypertension itself but from abnormalities in the erythrocyte cell membrane, because no increase in Na+ passive permeability was noted in either DSH or 2KH rats.
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PMID:Erythrocyte sodium ion transport system in DOC-salt, Goldblatt, and spontaneously hypertensive rats. 132 86

Dr. Skeggs demonstrated the lack of renin dependence in 1-kidney, 1-clip hypertension and elucidated some of the differences between that and Dr. Goldblatt's classic 2-kidney, 1-clip model of hypertension. Studies of these two different types of hypertension have led research in many new directions and helped to reveal the role of the renin-angiotensin system in hypertension and that system's interaction with sodium-induced vasodilation in both animals and humans. More recent research has investigated the processes behind essential hypertension and I present here the proposal that, due to nephron heterogeneity, essential hypertension in humans is parallel in its pathophysiologic processes to Goldblatt hypertension.
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PMID:On the mechanisms and clinical relevance of one-kidney, one-clip hypertension. 174 91

Morphologic evidence from patients with essential hypertension and Goldblatt-type hypertension reveals a subpopulation of narrowed afferent arterioles to ischemic nephrons. These ischemic nephrons, responding individually to their perception of underperfusion, secrete renin. In response, the normal nephrons are in adaptive natriuresis and have appropriately shut off their renin production. Nevertheless, they are affected adversely by the discordant renin-angiotensin II arising from the ischemic nephrons' presence, which exerts an unwanted sodium-retaining effect on the proximal tubules of the adapting nephrons. The end result is elevated blood pressure from too much sodium retention for the level of renin activity, that is, an abnormal renin-sodium product. Thus, "normal" renin levels in a hypertensive individual are abnormal because healthy kidneys shut off renin production entirely when blood pressure rises. This construction explains why angiotensin converting enzyme inhibition often corrects "normal" renin hypertension. Although such hypertension may be partly sodium-mediated as a consequence of inappropriate sodium retention by the normal and ischemic nephrons, the source of the problem lies in the renin production from ischemic nephrons. The correct treatment, then, is an antirenin therapy designed to block renin synthesis or secretion or angiotensin II formation or action. In view of modern studies suggesting that renin excesses also correlate with an increased risk of heart attack and stroke, the role of antirenin and antiangiotensin agents in treatment assumes additional relevance.
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PMID:Discordant nephron function. A pathogenic factor in hypertension and its vascular complications of stroke and heart attack. 200 43

Recent reports indicate that cyclooxygenase inhibitors such as aspirin may facilitate the release of interleukin-2 from thymic T cells. We have previously reported that aspirin has antihypertensive effects in the standard animal model of essential hypertension, the spontaneously hypertensive rat (SHR). Because the SHR has been reported to be deficient in T cells, it was of interest to determine whether the course of hypertension in this model could be altered by interleukin-2, the T cell growth factor. A single bolus of interleukin-2 (5,000 units/kg s.c.) prevented the increase of blood pressure in the young SHR and lowered pressure to normotensive levels in the well-established hypertensive adult SHR. In the latter, the effects of a single dose have been found to persist for at least 6 months with no toxic or untoward effects apparent. Blood pressure in Goldblatt, single-kidney wistar-kyoto rats, a model of renal hypertension, was not affected by interleukin-2.
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PMID:Antihypertensive effect of interleukin-2. 213 45

Baseline plasma vasopressin concentrations were measured in 48 men (all 50 years old) with decreased plasma renin concentration and untreated, sustained essential hypertension and in 29 healthy normotensive men. Mean hypertensive plasma vasopressin concentration was more than twice as high as the corresponding normotensive level (15.7 +/- 2.2 [SE] vs 7.5 +/- 1.0 pg/ml; p less than 0.001). Plasma renin concentration in the hypertensive group was reduced compared with that in the normotensive group (0.28 +/- 0.04 vs 0.46 +/- 0.06 Goldblatt units X 10(-4)/ml). These differences appeared despite virtually identical serum osmolality, creatinine clearance, and urinary sodium excretion in the two groups. In the first 38 hypertensive subjects, arterial plasma epinephrine concentrations were significantly increased over those of the first 28 control subjects (99 +/- 12 vs 68 +/- 6 pg/ml; p less than 0.025). In contrast to those with low renin essential hypertension, 35 men with normal renin essential hypertension (all 40 years old) had normal plasma vasopressin levels that were not significantly different from those in a comparable normotensive control group (3.7 +/- 0.8 vs 3.5 +/- 0.4 pg/ml). Arterial epinephrine concentrations were not significantly different between normal renin subjects and the control group. After 6 weeks of treatment with the nonselective beta-adrenergic receptor blocker oxprenolol in 11 subjects with low renin hypertension, blood pressure was reduced and the plasma vasopressin concentration fell from 27.6 +/- 6.4 to 13.5 +/- 4.2 pg/ml (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Increased plasma vasopressin in low renin essential hypertension. 287 61

We describe diastolic properties of the myocardium in terms of stress-strain relations. In a mathematical analysis, the equation sigma = alpha(e beta.epsilon-1) of the stress-strain curve can be changed by an increase in the exponent beta or the multiplicative constant alpha. It can be experimentally shown that in hypertrophied myocardium of rats with essential hypertension and renal hypertension (SHR and Goldblatt rats, respectively), the steepening of the stress-strain curve is associated with an increase in the exponent beta (stiffness constant) and an enhancement of collagen content. On the other hand, in acute hypoxic myocardium, the slope of the stress-strain curve is increased without a significant change of the exponent beta. Our results from heat measurements and quick-release experiments indicate that the hypoxic contracture (H) and the oxygen and glucose deficiency contracture (HG) are in contrast to the results of depolarization contracture (KCl) and experimental tetanus (T). In H and HG, the cross-bridge cycling rate was found to be slowed by a factor of 2,000 compared to KCl and T. This means that ATP demand for force development and maintenance is 2,000 times less in H and HG than in KCl and T. We will further discuss the meaning and implications of these experimental findings.
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PMID:Changes in myocardial distensibility in rat papillary muscle: fibrosis, KCl contracture, hypoxic contracture, oxygen and glucose deficiency contracture, and experimental tetanus. 295 60

The present review considers evidence that in chronic hypertension, hypertrophy of the muscles of the resistance vessels and left ventricle (LV) accounts for their intrinsic properties as haemodynamic amplifiers. In spontaneously hypertensive rats (SHR) there is early hypertrophy of both vessels and LV, suggesting that they may initiate hypertension; slow development of alpha-adrenoceptors may contribute to the early preponderance of the LV amplifier. In human hypertension LV hypertrophy occurs in most patients, including a high proportion of mild hypertensives. In Goldblatt one-kidney hypertension the stenosis resistance, which is the initiating cause, accounts for 25% of the rise in blood pressure throughout, with 75% initially due to systemic constrictor action of angiotensin II and later due to the amplifier properties of the hypertrophied heart and vessels. The cardiovascular amplifiers must be important in all chronic hypertension, so that if hypertrophy can be reversed, detection of the initiating mechanism should be easier. Studies in patients indicate that drug therapy can reverse hypertrophy and that subsequent redevelopment of hypertension is markedly slowed. We postulate an intrinsic disturbance of muscle performance in all primary hypertension, which may be triggered through the sympathetic nervous system in some patients and through altered cation transport in others.
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PMID:The cardiovascular amplifiers in human primary hypertension and their role in a strategy for detecting the underlying causes. 296 26

The introduction of angiotensin-converting-enzyme (ACE)-inhibitors into the analysis of the renin-angiotensin system (RAS) had broadened our knowledge of the integral role of renin and the kidney in circulatory homeostasis and has provided a pathophysiologically based concept for the treatment of hypertension. When the RAS is activated, as it is when sodium is restricted, the renal blood supply shows the most striking vasodilatation among vascular beds assessed after ACE-inhibition. Sodium excretion rises, there is a fall in blood-pressure, and plasma concentrations of angiotensin II (AII) and aldosterone are reduced. Conversely, with sodium loading the hemodynamic and hormonal effects of ACE-inhibitors are small. In 50-60% of normal or high-renin patients with essential hypertension ACE-inhibitors induce a potentiated acute renal response: renal blood flow and sodium excretion increase more than they do in the remainder of the hypertensives or in normal subjects. The responders of the hypertensive patients fail to increase renal blood flow or to enhance renal vascular responsiveness to infused AII when they shift from a low to a high sodium intake. The altered renal response of these "sodium-sensitive" hypertensives could be related to local activity of the RAS which is insufficiently suppressed by sodium loading. ACE-inhibition reverses this failure of the renal blood supply to respond to sodium loading. Kidneys of spontaneously hypertensive rats and the renin-rich kidney of Goldblatt-hypertensive rats show an increased tubulo glomerular (TG) feedback response as compared to normal kidneys. The change in TG-feedback response might be expected to contribute to the inability of the hypertensive kidney to respond adequately to sodium loading. ACE-inhibition reduces TG-feedback sensitivity. In renal artery stenosis glomerular capillary pressure tends to be maintained by an AII mediated rise in postglomerular resistance. Suppression of AII by ACE-inhibition reduces efferent vascular tone and thus filtration rate. There is a potential for interaction of ACE-inhibitors with the kallikrein and prostaglandin pathways as well as with the sympathetic nervous system and endogenous opioids. This may modify the renal and blood pressure responses to these compounds.
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PMID:[Angiotensin-converting enzyme inhibition: direct and indirect mechanisms]. 299 40

Although renin was identified as playing a part in cardiovascular homeostasis by the experiments of Goldblatt in the 1930s, neither its physiological role in organs other than the kidney nor its contribution to the genesis of essential hypertension have been defined. It is difficult to interpret studies with converting enzyme inhibitors because of their multiple pharmacological effects. Specific inhibitors of renin appropriate for clinical investigation would help to resolve many questions. Four classes of compounds have been shown to be renin inhibitors of high potency: specific antibody, general peptide inhibitors of acid proteases, analogues of angiotensinogens and peptides that are related to the amino-terminal sequence of prorenin. Of these, it is likely that angiotensinogen analogues will be the first applied in human studies. The minimal substrate for renin has the sequence: His-Pro-Phe-His-Leu-Val-Tyr. Variants of this sequence have yielded competitive inhibitors. Remarkably active compounds have recently been synthesized by reducing the peptide bond that is cleaved by renin, or by incorporating the amino acid statine, found in pepstatin. These compounds have been shown to be effective in dogs, rats and monkeys and, most recently, preliminary studies have reported their efficacy in man. Recent studies with one of these inhibitors, RIP, raise questions concerning both its specificity and site of action.
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PMID:Will renin inhibitors influence decision-making in antihypertensive therapy? 300 3


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