Azizi M, Guyene T T, Chatellier G, Ménard J
Broussais Hospital Clinical Investigation Centre, Assistance Publique des Hôpitaux de Paris, France.
J Hypertens. 1994 Apr;12(4):419-27.
To assess the participation of the renin-angiotensin system in the blood pressure regulation of essential hypertensive patients through acute specific renin inhibition.
Fifty-three consecutive untreated hypertensive patients (mean +/- SD age 55 +/- 10 years, 42 male) were investigated on their usual sodium diet in a 3-h protocol. The first 11 patients did not receive any drug, the following 20 patients ingested a single oral dose of captopril (1 mg/kg) and the last 22 patients received a renin inhibitor infusion (remikiren; 1 mg/kg over 60 min).
The maximum diastolic blood pressure fall was comparable in the two treated groups. Diastolic blood pressure changes analysed as area under the curve were similar for both drugs (overall F1,40 = 1.26, P = 0.27). Even though the baseline renin levels were within the narrow range 5-80 pg/ml, the diastolic blood pressure fall analysed as area under the curve from time 32 min to time 60 min was significantly correlated with the baseline active renin level in both groups (remikiren r = 0.44, P < 0.05; captopril r = 0.47, P < 0.05). The plasma active renin levels were significantly increased at 30, 90 and 120 min in both groups, and the maximum active renin levels were significantly correlated with the baseline active renin level (remikiren r = 0.62, P < 0.01; captopril r = 0.66, P < 0.01). The plasma prorenin levels did not change.
This study suggests that acute renin inhibition and acute angiotensin converting enzyme inhibition similarly decrease the blood pressure and increase the plasma active renin levels. Acute blockade of the renin-angiotensin system at its initial step by a renin inhibitor can therefore be used to investigate the renin dependence of the blood pressure in essential hypertension.
通过急性特异性肾素抑制来评估肾素-血管紧张素系统在原发性高血压患者血压调节中的作用。
对53例连续未经治疗的高血压患者（平均±标准差年龄55±10岁，42例男性）进行研究，在3小时的方案中采用其通常的钠饮食。前11例患者未接受任何药物治疗，接下来的20例患者口服单次剂量的卡托普利（1mg/kg），最后22例患者接受肾素抑制剂输注（瑞米吉仑；60分钟内1mg/kg）。
两个治疗组的最大舒张压下降幅度相当。以曲线下面积分析的舒张压变化在两种药物中相似（总体F1,40 = 1.26，P = 0.27）。尽管基线肾素水平在5 - 80 pg/ml的狭窄范围内，但从32分钟到60分钟以曲线下面积分析的舒张压下降与两组的基线活性肾素水平显著相关（瑞米吉仑r = 0.44，P < 0.05；卡托普利r = 0.47，P < 0.05）。两组在30、90和120分钟时血浆活性肾素水平显著升高，最大活性肾素水平与基线活性肾素水平显著相关（瑞米吉仑r = 0.62，P < 0.01；卡托普利r = 0.66，P < 0.01）。血浆肾素原水平未改变。
本研究表明，急性肾素抑制和急性血管紧张素转换酶抑制同样降低血压并升高血浆活性肾素水平。因此，肾素抑制剂在肾素-血管紧张素系统初始步骤的急性阻断可用于研究原发性高血压中血压的肾素依赖性。
