Matsubara H, Umeda Y, Yamane Y, Nishikawa M, Taniguchi T, Inada M
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Am J Cardiol. 1987 Sep 15;60(8):708-14. doi: 10.1016/0002-9149(87)90387-0.
Eighteen patients with essential hypertension were separated into 2 groups, renin-unresponsive and renin-responsive, on the basis of their plasma renin response when challenged by furosemide and upright posture. The response to acute infusion of hypertonic saline solution (1.4% saline solution at a rate of 0.3 ml/min/kg over 60 minutes) was then studied. In the renin-unresponsive group, peak rate of fractional excretion of sodium and peak urine flow after saline loading were 7.6 +/- 0.7% and 476 +/- 34 ml/hour, respectively, and peak value of atrial natriuretic polypeptides (ANP) was 784 +/- 140 pg/ml. In the renin-responsive group, the values were 3.1 +/- 0.4%, 194 +/- 29 ml/hour and 115 +/- 33 pg/ml. Both fractional excretion of sodium, urine flow and ANP response were significantly higher (p less than 0.01) in the renin-unresponsive group. Moreover, a highly significant relation (r = 0.82, p less than 0.01) was observed between fractional excretion of sodium and ANP levels in all hypertensive patients. The degree of saline-induced natriuresis was not related to blood pressure, heart rate, endogenous creatinine clearance, antidiuretic hormone or preexisting level of aldosterone. Plasma renin activity changed little in either group during saline infusion, but tended to be higher at all times in the renin-responsive patients. The present findings suggest that the enhanced secretion of ANP is an important determinant for exaggerated natriuresis observed in patients with renin-unresponsive hypertension.
18例原发性高血压患者根据速尿和直立姿势激发后的血浆肾素反应分为两组，即肾素无反应组和肾素反应组。然后研究了他们对急性输注高渗盐溶液（1.4%盐溶液，以0.3 ml/min/kg的速度在60分钟内输注）的反应。在肾素无反应组中，盐水负荷后钠的分数排泄峰值速率和尿流峰值分别为7.6±0.7%和476±34 ml/小时，心房利钠多肽（ANP）的峰值为784±140 pg/ml。在肾素反应组中，这些值分别为3.1±0.4%、194±29 ml/小时和115±33 pg/ml。肾素无反应组的钠分数排泄、尿流和ANP反应均显著更高（p<0.01）。此外，在所有高血压患者中，钠分数排泄与ANP水平之间观察到高度显著的相关性（r = 0.82，p<0.01）。盐水诱导的利钠程度与血压、心率、内生肌酐清除率、抗利尿激素或醛固酮的预先存在水平无关。在盐水输注期间，两组的血浆肾素活性变化均很小，但肾素反应性患者在所有时间点往往更高。目前的研究结果表明，ANP分泌增加是肾素无反应性高血压患者中观察到的过度利钠的重要决定因素。
