Igarashi Y, Suzuki H, Imafuku T, Saito I, Saruta T
Jpn Circ J. 1987 May;51(5):479-84. doi: 10.1253/jcj.51.479.
The effects of volume-loading and removal on mean blood pressure were evaluated in patients with high blood pressure and on chronic hemodialysis. Simultaneous measurements of plasma renin activity, plasma angiotensin II and plasma norepinephrine were made. The patients were divided into two groups according to their levels of plasma renin activity. Group 1 (n = 10) had a basal plasma renin activity below 2.5 ng/ml/hr while the level in group 2 (n = 5) exceeded 2.5 ng/ml/hr. The mean blood pressure of the two groups was 105 +/- 5 mmHg and 107 +/- 4 mmHg, respectively. On the day of hemodialysis, saline loading (0.5 ml/kg/min for 20 min) was followed by routine hemodialysis. The mean blood pressure rose to 113 +/- 6 mmHg in group 1. However, the patients in group 2 did not respond to volume loading and hemodialysis. The plasma renin activity, plasma angiotensin II and plasma norepinephrine were not changed by volume loading in both group 1 and 2. Volume removal by hemodialysis caused a reduction in mean blood pressure in group 2 without alteration of vasoactive hormones. In group 1, the mean blood pressure was not reduced by hemodialysis, accompanied by increases in plasma renin activity, plasma angiotensin II, and plasma norepinephrine. In the high renin group, elevated circulating angiotensin II maintained a high blood pressure and in the low renin group, the renin-angiotensin system influenced the prevention of fall in blood pressure after hemodialysis. These results suggest that the renin-angiotensin system plays an important role in the regulation of blood pressure in relation to volume status regardless of whether the plasma renin activity is high or low.
在高血压且接受慢性血液透析的患者中，评估了容量负荷增加和清除对平均血压的影响。同时测定了血浆肾素活性、血浆血管紧张素II和血浆去甲肾上腺素。根据血浆肾素活性水平将患者分为两组。第1组（n = 10）基础血浆肾素活性低于2.5 ng/ml/小时，而第2组（n = 5）的水平超过2.5 ng/ml/小时。两组的平均血压分别为105±5 mmHg和107±4 mmHg。在血液透析当天，先进行生理盐水负荷（0.5 ml/kg/分钟，共20分钟），然后进行常规血液透析。第1组平均血压升至113±6 mmHg。然而，第2组患者对容量负荷和血液透析无反应。第1组和第2组容量负荷均未改变血浆肾素活性、血浆血管紧张素II和血浆去甲肾上腺素。血液透析清除容量导致第2组平均血压降低，而血管活性激素未改变。在第1组中，血液透析未降低平均血压，同时血浆肾素活性、血浆血管紧张素II和血浆去甲肾上腺素增加。在高肾素组中，循环血管紧张素II升高维持高血压，而在低肾素组中，肾素-血管紧张素系统影响血液透析后血压下降的预防。这些结果表明，无论血浆肾素活性高低，肾素-血管紧张素系统在与容量状态相关的血压调节中起重要作用。
