Lohmeier T E, Montani J P, Smith M J, Rushing E L
Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson 39216-4505.
Hypertension. 1989 Mar;13(3):273-82. doi: 10.1161/01.hyp.13.3.273.
This study was designed to examine the mechanisms that contribute to the chronic hypotensive effects of verapamil during angiotensin II-induced hypertension. Hypertension was induced in five dogs by continuous intravenous infusion of angiotensin II (5 ng/kg/min) for 17 days. On the sixth day of angiotensin II infusion when daily sodium balance was achieved, mean arterial pressure (control, 92 +/- 4 mm Hg), plasma aldosterone concentration (control, 5.2 +/- 0.9 ng/dl), and renal resistance (control, 0.28 +/- 0.01 mm Hg/ml/min) were increased 37 +/- 8 mm Hg, 13.6 +/- 5.0 ng/dl, and 0.20 +/- 0.05 mm Hg/ml/min, respectively. At this time there were no significant changes in glomerular filtration rate, effective renal plasma flow, net sodium and water balance, or extracellular fluid volume. Subsequently, when verapamil was infused (at 2 micrograms/kg/min) simultaneously with angiotensin II (days 7-13), there was a net loss of 55 +/- 10 meq sodium, a 7.0 +/- 0.7% fall in extracellular fluid volume, and approximately a 70% reduction in the chronic effects of angiotensin II on mean arterial pressure and renal resistance; in contrast, verapamil failed to attenuate the long-term aldosterone response to angiotensin II. Further, although glomerular filtration rate and effective renal plasma flow tended to increase during verapamil administration, there were no consistent chronic long-term changes in these renal indexes. In comparison with these responses in hypertensive dogs, when verapamil was infused for 7 days before the induction of angiotensin II hypertension, there were no significant changes in any measurements except mean arterial pressure, which fell 11 +/- 1 mm Hg. Thus, these data fail to support the hypothesis that the chronic stimulatory actions of angiotensin II on aldosterone secretion are dependent on a sustained increase in transmembranal calcium influx. Moreover, these data indicate that the pronounced long-term hypotensive effects of verapamil in angiotensin II hypertension are due to impairment of the direct renal actions of angiotensin II rather than the indirect sodium-retaining effects that are mediated via aldosterone secretion.
本研究旨在探讨维拉帕米在血管紧张素II诱导的高血压过程中产生慢性降压作用的机制。通过连续静脉输注血管紧张素II(5 ng/kg/分钟)17天,使5只犬诱发高血压。在输注血管紧张素II的第6天,当日钠平衡达到时,平均动脉压(对照,92±4 mmHg)、血浆醛固酮浓度(对照,5.2±0.9 ng/dl)和肾血管阻力(对照,0.28±0.01 mmHg/ml/分钟)分别升高37±8 mmHg、13.6±5.0 ng/dl和0.20±0.05 mmHg/ml/分钟。此时,肾小球滤过率、有效肾血浆流量、钠和水平衡或细胞外液量均无显著变化。随后,当维拉帕米(以2微克/千克/分钟)与血管紧张素II同时输注时(第7 - 13天),钠净丢失55±10 meq,细胞外液量下降7.0±0.7%,血管紧张素II对平均动脉压和肾血管阻力的慢性作用降低约70%;相比之下,维拉帕米未能减弱血管紧张素II对醛固酮的长期反应。此外,虽然在维拉帕米给药期间肾小球滤过率和有效肾血浆流量有升高趋势,但这些肾脏指标并无一致的慢性长期变化。与高血压犬的这些反应相比,在诱发血管紧张素II高血压前7天输注维拉帕米时,除平均动脉压下降11±1 mmHg外,其他测量指标均无显著变化。因此,这些数据不支持血管紧张素II对醛固酮分泌的慢性刺激作用依赖于跨膜钙内流持续增加这一假说。此外,这些数据表明,维拉帕米在血管紧张素II高血压中的显著长期降压作用是由于血管紧张素II的直接肾脏作用受损,而非通过醛固酮分泌介导的间接保钠作用。