Kinugawa T, Endo A, Kato M, Kato T, Ahmmed G U, Omodani H, Osaki S, Ogino K, Hisatome I, Miyakoda H, Fujimoto Y, Yoshida A, Shigemasa C
First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Cardiology. 1997 May-Jun;88(3):238-45. doi: 10.1159/000177336.
Neurohormonal responses to exercise have not been studied fully in patients with essential hypertension (HT). This study determined if neurohormonal responses to exercise are altered between three subgroups of HT categorized by basal plasma renin activity (PRA). Plasma norepinephrine, epinephrine, atrial natriuretic peptide (ANP), PRA, angiotensin II (AII), and aldosterone were measured at rest and after submaximal treadmill exercise in 39 patients with essential HT (WHO classes I-II) and 13 controls. Patients with HT were divided into three subgroups based on the PRA level [low-renin (< 0.5) HT (n = 14), normal-renin (0.5-2.0) HT (n = 13), and high-renin (> 2.0) HT (n = 12)]. Patients with HT had higher blood pressure during exercise compared to controls, but blood pressure responses were similar among low-, normal-, and high-renin HT. Neurohormonal factors were comparable between all hypertensives and controls, except for higher plasma AII at rest in patients with HT. When neurohormones were compared among three subgroups of HT, plasma norepinephrine and epinephrine responses were similar. Patients with high-renin HT had higher PRA and AII, and lower ANP levels at rest and after exercise. In all hypertensives, negative correlations were observed between resting PRA and resting ANP (r = -0.41, p < 0.01), as well as peak PRA and peak ANP (r = -0.33, p < 0.05). Thus, neurohormonal responses to exercise varied with similar cardiac responses among subgroups of essential HT stratified according to renin levels. Patients with high-renin HT had augmented renin-angiotensin system activity with a decrease in ANP levels both at rest and after exercise. A reciprocal relationship between renin-angiotensin system activity and ANP was observed both at rest and after exercise in HT.
对于原发性高血压（HT）患者，运动时神经激素反应尚未得到充分研究。本研究确定了根据基础血浆肾素活性（PRA）分类的HT三个亚组之间运动时神经激素反应是否存在改变。对39例原发性HT（WHO分级I-II级）患者和13名对照者在静息状态及次极量平板运动后测定血浆去甲肾上腺素、肾上腺素、心房利钠肽（ANP）、PRA、血管紧张素II（AII）和醛固酮。根据PRA水平将HT患者分为三个亚组[低肾素（<0.5）HT（n = 14）、正常肾素（0.5 - 2.0）HT（n = 13）和高肾素（>2.0）HT（n = 12）]。与对照者相比，HT患者运动时血压更高，但低肾素、正常肾素和高肾素HT患者的血压反应相似。除HT患者静息时血浆AII较高外，所有高血压患者和对照者之间的神经激素因素具有可比性。当比较HT三个亚组之间的神经激素时，血浆去甲肾上腺素和肾上腺素反应相似。高肾素HT患者静息和运动后PRA和AII较高，ANP水平较低。在所有高血压患者中，观察到静息PRA与静息ANP之间呈负相关（r = -0.41，p < 0.01），以及峰值PRA与峰值ANP之间呈负相关（r = -0.33，p < 0.05）。因此，根据肾素水平分层的原发性HT亚组中，运动时神经激素反应有所不同，但心脏反应相似。高肾素HT患者静息和运动后肾素-血管紧张素系统活性增强，ANP水平降低。在HT患者静息和运动后均观察到肾素-血管紧张素系统活性与ANP之间存在相互关系。
