Rizzoni D, Agabiti-Rosei E, Castellano M, Muiesan M L, Beschi M, Rossini P, Montani G, Pizzocolo G, Poiesi C, Rodella A
Clinica Medica Generale e Terapia Medica, Università degli Studi, Brescia.
Cardiologia. 1990 May;35(5):415-22.
The involvement of cardiopulmonary and arterial sinoaortic receptors in the control of antidiuretic hormone (ADH) and atrial natriuretic peptide (ANP) release is still controversial in humans. Moreover, it is not clear if this control may be impaired in hypertensive patients with left ventricular hypertrophy (LVH). We studied 17 male subjects, age 18-58 (6 normotensives and 9 mild hypertensives, 5 without and 4 with LVH). Each subject underwent selective loading and unloading of cardiopulmonary receptors, in a randomized sequence, by application of a positive (LBPP) or negative (LENP) pressure to the lower body (steps: +10, +20, +40, -10, -40 mmHg, each for about 30 min), through a plexyglass-constructed tubular apparatus with a rubber adhesion round the patients' waist. Blood samples were taken at the end of every step for measurement of ADH, ANP, PRA, immunoreactive renin, aldosterone, noradrenaline and adrenaline. Cuff arterial pressure was measured every 5 min, while heart rate was evaluated by continuous ECG recording. Hypertensive subjects underwent right atrial pressure measurement by an iv catheter and forearm blood flow evaluation at rest and during the different steps (venous occlusion plethysmography). During LBNP, ADH plasma levels increased progressively, but the increase became statistically significant only at the step of -40 mmHg. ANP increased significantly during LBPP. Taking into account only hypertensive patients, a consistent reduction in the changes of ADH and ANP plasma levels, respectively during LBNP and LBPP in patients with LVH in respect to those without LVH was found.(ABSTRACT TRUNCATED AT 250 WORDS)
心肺和动脉窦主动脉受体在抗利尿激素(ADH)和心房利钠肽(ANP)释放控制中的作用在人类中仍存在争议。此外,尚不清楚这种控制在伴有左心室肥厚(LVH)的高血压患者中是否会受损。我们研究了17名年龄在18至58岁之间的男性受试者(6名血压正常者和9名轻度高血压患者,其中5名无LVH,4名有LVH)。通过一个用 plexyglass 制成的管状装置,在患者腰部围上橡胶圈,对下半身施加正压(下肢正压,LBPP)或负压(下肢负压,LENP)(步骤:+10、+20、+40、-10、-40 mmHg,每个步骤约30分钟),以随机顺序对每个受试者进行心肺受体的选择性加载和卸载。在每个步骤结束时采集血样,用于测量ADH、ANP、肾素活性(PRA)、免疫反应性肾素、醛固酮、去甲肾上腺素和肾上腺素。每5分钟测量一次袖带动脉压,同时通过连续心电图记录评估心率。高血压受试者通过静脉导管测量右心房压力,并在静息和不同步骤期间评估前臂血流量(静脉阻塞体积描记法)。在下肢负压期间,ADH血浆水平逐渐升高,但仅在-40 mmHg步骤时升高才具有统计学意义。在下肢正压期间,ANP显著升高。仅考虑高血压患者,发现有LVH的患者在下肢负压和下肢正压期间,ADH和ANP血浆水平变化相对于无LVH的患者有一致的降低。(摘要截短至250字)