Jacobs M C, Lenders J W, Willemsen J J, Thien T
Department of Medicine, St Radboud University Hospital, Nijmegen, Netherlands.
Hypertension. 1997 Jun;29(6):1303-8. doi: 10.1161/01.hyp.29.6.1303.
To assess whether patients with mild essential hypertension have excessive activities of the sympathoneuronal and adrenomedullary systems, we examined total body and forearm spillovers and norepinephrine and epinephrine clearances in 47 subjects with mild essential hypertension (25 men, 22 women, aged 38.1 +/- 6.7 years) and 43 normotensive subjects (19 men, 24 women, aged 36.5 +/- 5.9 years). The isotope dilution method with infusions of tritiated norepinephrine and epinephrine was used at rest and during sympathetic stimulation by lower body negative pressure at -15 and -40 mm Hg. Hypertensive subjects had a higher arterial plasma epinephrine concentration (0.20 +/- 0.01 nmol.L-1: mean +/- SE) than normotensive subjects (0.15 +/- 0.01) (P < .01). The increased arterial plasma epinephrine levels appeared to be due to a higher total body epinephrine spillover rate in the hypertensive subjects (0.23 +/- 0.02 nmol.min-1.m-2) than the normotensive subjects (0.18 +/- 0.01) (P < .05) and not to a decreased plasma clearance of epinephrine. The arterial plasma norepinephrine level, total body and forearm norepinephrine spillover rates, and plasma norepinephrine clearance were not altered in the hypertensive subjects. The responses of the catecholamine kinetic variables to lower body negative pressure were not consistently different between normotensive and hypertensive individuals. These data indicate that individuals with mild essential hypertension (1) have elevated arterial plasma epinephrine concentrations that are due to an increased total body epinephrine spillover rate, indicating an increased adrenomedullary secretion of epinephrine; (2) have no increased generalized sympathoneuronal activity and no increased forearm norepinephrine spillover; and (3) have similar responses of both the sympathoneuronal and adrenomedullary systems to sympathetic stimulation by lower body negative pressure.
为评估轻度原发性高血压患者的交感神经和肾上腺髓质系统活动是否过度，我们检测了47例轻度原发性高血压患者（25例男性，22例女性，年龄38.1±6.7岁）和43例血压正常者（19例男性，24例女性，年龄36.5±5.9岁）的全身及前臂去甲肾上腺素和肾上腺素溢出率以及清除率。采用氚标记去甲肾上腺素和肾上腺素输注的同位素稀释法，分别在静息状态以及下半身负压为-15和-40 mmHg进行交感神经刺激时检测。高血压患者动脉血浆肾上腺素浓度（0.20±0.01 nmol·L-1：均值±标准误）高于血压正常者（0.15±0.01）（P<0.01）。高血压患者动脉血浆肾上腺素水平升高似乎是由于全身肾上腺素溢出率高于血压正常者（0.23±0.02 nmol·min-1·m-2）（0.18±0.01）（P<0.05），而非肾上腺素血浆清除率降低所致。高血压患者的动脉血浆去甲肾上腺素水平、全身及前臂去甲肾上腺素溢出率以及血浆去甲肾上腺素清除率均未改变。血压正常者和高血压患者之间，儿茶酚胺动力学变量对下半身负压的反应并无一致差异。这些数据表明，轻度原发性高血压患者：（1）动脉血浆肾上腺素浓度升高，这是由于全身肾上腺素溢出率增加，提示肾上腺髓质肾上腺素分泌增加；（2）全身交感神经活动未增加，前臂去甲肾上腺素溢出也未增加；（3）交感神经和肾上腺髓质系统对下半身负压交感神经刺激的反应相似。
