Lifschitz M D, Kirschenbaum M A, Rosenblatt S G, Gibney R
Ann Intern Med. 1978 Jan;88(1):23-7. doi: 10.7326/0003-4819-88-1-23.
Hypertension in patients on chronic hemodialysis is thought to be largely of two types--volume dependent or renin dependent. If renin-dependent hypertension is mediated by angiotensin II, then angiotensin II antagonism should lower blood pressure. To test this hypothesis, the angiotensin II antagonist saralasin was given to 15 hypertensive patients on chronic hemodialysis. Patients were separated into two groups by their blood pressure response. In responders blood pressure was 191/112 mm Hg and fell to 147/85 during saralasin administration (P less than 0.01). In contrast, nonresponders had blood pressures of 190/111 mm Hg before and 188/110 during saralasin administration. Five responders subsequently ahd nephrectomies with normalization of their blood pressures. Plasma renin activity averaged 70 ng/ml . 3 h of angiotensin I in responders and increased to 110 after saralasin (P less than 0.05), while nonresponders had values of 21 before and after saralasin. These results offer strong support for the hypothesis that renin-dependent hypertension is an important mechanism in certain patients on chronic hemodialysis and that such patients will respond to angiotensin II antagonism.
慢性血液透析患者的高血压在很大程度上被认为有两种类型——容量依赖性或肾素依赖性。如果肾素依赖性高血压是由血管紧张素II介导的，那么血管紧张素II拮抗作用应该能降低血压。为了验证这一假设，对15名接受慢性血液透析的高血压患者给予了血管紧张素II拮抗剂沙拉新。根据患者的血压反应将其分为两组。有反应者的血压为191/112 mmHg，在给予沙拉新期间降至147/85（P<0.01）。相比之下，无反应者在给予沙拉新前血压为190/111 mmHg，给药期间为188/110。5名有反应者随后接受了肾切除术，血压恢复正常。有反应者的血浆肾素活性平均为70 ng/ml·3h血管紧张素I，给予沙拉新后升至110（P<0.05），而无反应者在给予沙拉新前后的值均为21。这些结果有力地支持了以下假设：肾素依赖性高血压是某些慢性血液透析患者的重要机制，并且此类患者会对血管紧张素II拮抗作用产生反应。
