Atkinson A B, Brown J J, Davies D L, Leckie B, Lever A F, Morton J J, Robertson J I
Hypertension. 1981 Jan-Feb;3(1):53-8. doi: 10.1161/01.hyp.3.1.53.
The case is reported of a young woman with severe hypertension, unilateral renal artery stenosis, variously normal or marginally high plasma concentrations of active renin, angiotensin II, aldosterone, sodium, and potassium; and normal total exchangeable and total body sodium and potassium. Arteriograms and ureter catheterization showed the stenosis to be severe, but the unstimulated renal vein renin and angiotensin II differential to be modest. Captopril caused an initial fall in angiotensin II and arterial pressure. During prolonged captopril treatment, plasma angiotensin II and aldosterone remained depressed; exchangeable and total body sodium and potassium were unaltered. Blood pressure fell further to normal levels during prolonged captopril treatment, while subsequent surgical correction of the renal artery stenosis was curative; absolute values of blood pressure and plasma angiotensin II were similar in both situations. The findings support, without proving, the concept that chronic modest elevation of angiotensin II may be responsible for sustained hypertension in unilateral renal artery stenosis. Patients of this type contrast sharply with those, also with severe renal artery stenosis or occlusion, who have gross elevation of renin, angiotensin II, and aldosterone, with sodium and potassium deficiency. Captopril or surgery are effective in both syndromes, but the manner of response to treatment differs markedly.
报告了一例年轻女性病例，该患者患有严重高血压、单侧肾动脉狭窄，血浆活性肾素、血管紧张素II、醛固酮、钠和钾浓度正常或略高；可交换钠总量和全身钠钾总量正常。动脉造影和输尿管插管显示狭窄严重，但未刺激的肾静脉肾素和血管紧张素II差异不大。卡托普利导致血管紧张素II和动脉压最初下降。在长期卡托普利治疗期间，血浆血管紧张素II和醛固酮仍处于低水平；可交换钠总量和全身钠钾总量未改变。在长期卡托普利治疗期间，血压进一步降至正常水平，而随后对肾动脉狭窄进行手术矫正则可治愈；两种情况下血压和血浆血管紧张素II的绝对值相似。这些发现虽未证实，但支持了这样一种观点，即血管紧张素II的慢性适度升高可能是单侧肾动脉狭窄持续高血压的原因。这类患者与那些同样患有严重肾动脉狭窄或闭塞、肾素、血管紧张素II和醛固酮大幅升高且伴有钠钾缺乏的患者形成鲜明对比。卡托普利或手术对这两种综合征均有效，但对治疗的反应方式明显不同。
