Wenting G H, Man in 't Veld A J, Verhoeven R P, Derkx F H, Schalekamp D H
Circ Res. 1977 May;40(5 Suppl 1):I163-70.
Serial measurements of urinary sodium excretion, sodium space, plasma volume, and plasma renin concentration were made during the development of hypertension in patients who were exposed to an excess of endogenous or exogenous mineralocorticoid activity. Five patients with primary aldosteronism due to adenoma were followed during spironolactone treatment, for 35-55 days after the drug had been stopped, and finally, after surgery. Blood pressure rose continuously after stopping spironolactone. Sodium balance, however, showed an initial phase of sodium gain, followed by a phase of gradual sodium loss. Sodium space and exchangeable sodium rose by 5.0 +/- 0.48 liters/1.73 m2 of body surface area (BSA) (P less than 0.005) and by 865 +/- 97 mEq/1.73 m2 BSA (P less than 0.005), respectively; the values were maximal after 10-15 days, declined afterward, but remained higher than during spironolactone treatment. Plasma and blood volumes rose by 624 +/- 90 ml/1.73 m2 BSA (P less than 0.005) and by 327 +/- 74 ml/1.73 m2 BSA (P less than 0.01), respectively; they were maximal after 20-25 days, and then returned to their initial values. Exchangeable sodium, during the phase of sodium loss, was inversely correlated with the rise in blood pressure (P less than 0.01). Renin fell during the phase of sodium gain, and remained low afterwards. Blood pressure and sodium space declined after surgery, but plasma volume showed no change. The postsurgery values of these parameters were not significantly different from those measured during spironolactone treatment. Two subjects with adrenocortical insufficiency, who were followed for 45-60 days during treatment with dexamethasone and 9alpha-fluorocortisol acetate, also showed a transient rise in sodium space and plasma volume. The results suggest a redistribution of body fluids during development of hypertension. They also suggest that the tendency of body fluid volumes to return to normal is pressure-dependent. The long-term effects of mineralocorticoid excess on the interrelations between pressure, volume, and renin bear some resemblance to the pattern observed in patients with established essential hypertension, i.e., pressure remains elevated despite a decrease of volume, and renin is "inappropriately" suppressed in relation to the sodium and volume status.
在因内源性或外源性盐皮质激素活性过高而发生高血压的患者中，对尿钠排泄、钠空间、血浆容量和血浆肾素浓度进行了连续测量。对5例因腺瘤导致原发性醛固酮增多症的患者在螺内酯治疗期间、停药后35 - 55天以及最终手术后进行了随访。停用螺内酯后血压持续升高。然而，钠平衡显示出一个最初的钠潴留期，随后是一个逐渐失钠的阶段。钠空间和可交换钠分别增加了5.0±0.48升/1.73平方米体表面积（BSA）（P<0.005）和865±97毫当量/1.73平方米BSA（P<0.005）；这些值在10 - 15天后达到最大值，随后下降，但仍高于螺内酯治疗期间。血浆和血容量分别增加了624±90毫升/1.73平方米BSA（P<0.005）和327±74毫升/1.73平方米BSA（P<0.01）；它们在20 - 25天后达到最大值，然后恢复到初始值。在失钠阶段，可交换钠与血压升高呈负相关（P<0.01）。在钠潴留期肾素下降，之后一直保持在低水平。手术后血压和钠空间下降，但血浆容量无变化。这些参数的术后值与螺内酯治疗期间测量的值无显著差异。两名肾上腺皮质功能不全的受试者在接受地塞米松和醋酸9α - 氟皮质醇治疗的45 - 60天内，也显示出钠空间和血浆容量的短暂增加。结果表明高血压发展过程中体液会重新分布。它们还表明体液量恢复正常的趋势是压力依赖性的。盐皮质激素过多对压力、容量和肾素之间相互关系的长期影响与在已确诊的原发性高血压患者中观察到的模式有一些相似之处，即尽管容量减少但血压仍升高，并且肾素相对于钠和容量状态“不适当”地受到抑制。
