有高血压和血压正常父母的血压正常受试者的肾血流动力学和肾素-血管紧张素-醛固酮系统

Renal hemodynamics and the renin-angiotensin-aldosterone system in normotensive subjects with hypertensive and normotensive parents.

作者信息

van Hooft I M, Grobbee D E, Derkx F H, de Leeuw P W, Schalekamp M A, Hofman A

机构信息

Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.

出版信息

N Engl J Med. 1991 May 9;324(19):1305-11. doi: 10.1056/NEJM199105093241902.

DOI:10.1056/NEJM199105093241902

PMID:2017226

Abstract

BACKGROUND AND METHODS

The kidney is important in blood-pressure regulation, but its role in the development of essential hypertension is still subject to debate. We compared renal hemodynamics, measured in terms of the clearance of para-aminohippuric acid and inulin, and the characteristics of the renin-angiotensin-aldosterone system in three groups of normotensive subjects at different degrees of risk for hypertension: 41 subjects with two normotensive parents, 52 with one normotensive and one hypertensive parent, and 61 with two hypertensive parents. The subjects ranged in age from 7 to 32 years.

RESULTS

The mean renal blood flow was lower in the subjects with two hypertensive parents than in those with two normotensive parents (mean difference [+/- SE], 198 +/- 61 ml per minute per 1.73 m2 of body-surface area; P = 0.002). Moreover, both the filtration fraction and renal vascular resistance were higher in the subjects with two hypertensive parents (filtration fraction: mean difference, 3.0 +/- 1.1 percentage points; P = 0.006; renal vascular resistance: mean difference, 2.7 +/- 0.8 mm Hg per deciliter per minute per 1.73 m2; P = 0.006). The subjects with two hypertensive parents had lower plasma concentrations of renin (mean difference, 3.3 +/- 1.6 mU per liter; P = 0.03) and aldosterone (mean difference, 111 +/- 36 pmol per liter; P = 0.003) than those with two normotensive parents. The differences could not be explained by the small differences in blood pressure between the groups. The values in the subjects with one hypertensive and one normotensive parent fell between those for the other two groups.

CONCLUSIONS

Renal vasoconstriction is increased and renin and aldosterone secretion is decreased in young persons at risk for hypertension. These findings support the hypothesis that alterations in renal hemodynamics occur at an early stage in the development of familial hypertension.

摘要

背景与方法

肾脏在血压调节中起重要作用，但其在原发性高血压发生中的作用仍存在争议。我们比较了三组不同高血压风险程度的正常血压受试者的肾血流动力学（以对氨基马尿酸清除率和菊粉清除率衡量）以及肾素 - 血管紧张素 - 醛固酮系统的特征：41名父母均为正常血压的受试者、52名父母一方为正常血压另一方为高血压的受试者以及61名父母均为高血压的受试者。受试者年龄在7至32岁之间。

结果

父母均为高血压的受试者的平均肾血流量低于父母均为正常血压的受试者（平均差值[±标准误]，每1.73平方米体表面积每分钟198±61毫升；P = 0.002）。此外，父母均为高血压的受试者的滤过分数和肾血管阻力均较高（滤过分数：平均差值，3.0±1.1个百分点；P = 0.006；肾血管阻力：平均差值，每1.73平方米每分钟每分升2.7±0.8毫米汞柱；P = 0.006）。父母均为高血压的受试者的血浆肾素浓度（平均差值，每升3.3±1.6毫单位；P = 0.03）和醛固酮浓度（平均差值，每升111±36皮摩尔；P = 0.003）低于父母均为正常血压的受试者。这些差异不能用各组间血压的微小差异来解释。父母一方为高血压另一方为正常血压的受试者的值介于其他两组之间。结论：有高血压风险的年轻人肾血管收缩增强，肾素和醛固酮分泌减少。这些发现支持了家族性高血压发展早期肾血流动力学发生改变的假说。