Effect of Sympathetic Nerve Inhibition on the State of Sodium—Volume Balance in Hypertensive Patients with Normal or Impaired Renal Function

1982 ◽  
Vol 63 (s8) ◽  
pp. 301s-303s ◽  
Author(s):  
V. M. Campes ◽  
D. Levitan ◽  
M. S. Romoff ◽  
Y. Saglikes ◽  
I. Sajo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Essential Hypertension ◽  
Impaired Renal Function ◽  
Plasma Renin ◽  
Plasma Noradrenaline ◽  
Mean Blood Pressure ◽  
Volume Balance ◽  
Group 2 ◽  
Group 1

1. The effect of clonidine on the relationship between sympathetic nervous system activity and the state of sodium-volume balance was studied in 15 patients with essential hypertension and normal renal function (group 1) and in 14 patients with hypertension and mild to moderate renal failure (group 2). 2. Acutely, clonidine (200 μg) produced significant falls (P < 0.01) in mean blood pressure, plasma noradrenaline, plasma renin activity and plasma aldosterone in both groups of patients. The changes in mean blood pressure were significantly correlated (P < 0.01) with the changes in plasma noradrenaline. 3. Chronic therapy with clonidine also produced significant falls in mean blood pressure and plasma noradrenaline, but not in plasma renin activity or aldosterone. 4. Exchangeable sodium and plasma volume decreased significantly in patients of group 1 but not in patients of group 2. 5. The data indicate that sympathetic nerve activity may be important for the abnormal relationship between pressure and natriuresis in subjects with essential hypertension and normal renal function, but not in hypertensive subjects with impaired renal function.

Differential Effects of Acute and Chronic β-Adrenoreceptor Blockade on Blood Pressure and the Renin—Angiotensin—Aldosterone System in Essential Hypertension

1976 ◽  
Vol 51 (s3) ◽  
pp. 537s-540s
Author(s):  
R. Kolloch ◽  
K. O. Stumpe ◽  
H. Vetter ◽  
W. Gramann ◽  
F. Krück
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Chronic Administration ◽  
Plasma Renin ◽  
Plasma Aldosterone ◽  
Receptor Blockade ◽  
Plasma Aldosterone Concentration ◽  
Group 2 ◽  
Β Receptor ◽  
Group 1

1. Serial measurements of plasma renin activity (PRA), plasma aldosterone concentration (PA) and blood pressure were performed overnight in patients with borderline (group 1) and sustained essential hypertension (group 2) before and after acute and chronic administration of either propranolol or pindolol. 2. Group 1 patients exhibited a typical rhythm of recumbent PRA with low values before midnight and large increases early in the morning. 3. In contrast, no rhythm and very low PRA values were observed in patients of group 2. Blood pressure was higher in group 2 than in group 1. There was a significant correlation between the hyporeninaemic and hypotensive effect of either acute (r = 0·79) or chronic (r = 0·4) β-receptor blockade. 4. In group 1, after β-receptor blockade the day—night profile of renin was similar to that observed in group 2 before treatment. Thus, in this latter subgroup, low-renin profiles might reflect reduced β-adrenoreceptor activity. 5. Plasma aldosterone was lower in group 2 but appeared to be inappropriately high relative to renin. 6. The data suggest that in hypertensive patients classified according to their blood pressure and recumbent PRA profiles a significant relationship exists between changes in PRA and arterial pressure. Thus patients with high PRA respond better to treatment than patients with low renin. We conclude that in the patients studied sympathetic nervous system activity mainly determined renin values as well as anti-hypertensive effectiveness of the β-blocking drugs.

scholarly journals Impact of Simultaneous Consideration of Cardiac and Vascular Function on Long-Term All-Cause and Cardiovascular Mortality

2019 ◽  
Vol 8 (12) ◽  
pp. 2145
Author(s):  
Po-Chao Hsu ◽  
Wen-Hsien Lee ◽  
Wei-Chung Tsai ◽  
Chun-Yuan Chu ◽  
Ying-Chih Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vascular Function ◽  
Mean Blood Pressure ◽  
Left Ventricular Ejection ◽  
Pressure Group ◽  
Versus Group ◽  
Group 4 ◽  
All Cause Mortality ◽  
Group 2 ◽  
Group 1

Background: Left ventricular ejection fraction (LVEF) is a good indicator of cardiac function, and brachial-ankle pulse wave velocity (baPWV) is a good indicator of vascular function. Both of them can predict cardiovascular (CV) outcomes. Objectives: There is scarce literature discussing the impact of simultaneous consideration of cardiac and vascular function on overall and CV mortality. Methods: We included 958 patients and classified them into four groups. Groups 1 to 4 were patients with LVEF ≥ 50% and baPWV below the median, LVEF < 50% but baPWV below the median, LVEF ≥ 50% but baPWV above the median, and LVEF < 50% and baPWV above the median, respectively. Results: The median follow-up to mortality was 93 (25th–75th percentile: 69–101) months. There were 91 cases of CV mortality and 238 cases of all-cause mortality. After multivariable analysis, age, gender, diabetes, mean blood pressure, group 2 versus group 1, and group 4 versus group 1 were significant predictors of all-cause mortality (P ≤ 0.038) and age, diabetes, mean blood pressure, group 2 versus group 1, and group 4 versus group 1 were significant predictors of CV mortality (P ≤ 0.008). Conclusions: Patients with higher LVEF and lower baPWV had a similar overall and CV mortality as patients with higher LVEF and baPWV. Patients with lower LVEF and higher baPWV had the highest overall and CV mortality among the four study groups. In addition, patients with lower LVEF alone had a higher CV mortality than the patients with higher baPWV alone. Therefore, simultaneous consideration of cardiac and vascular function may be useful in predicting overall and CV mortality.

Plasma Catecholamines and Renin Activity in Response to Exercise in Patients with Essential Hypertension

1975 ◽  
Vol 49 (5) ◽  
pp. 511-514
Author(s):  
J. Chodakowska ◽  
K. Nazar ◽  
B. Wocial ◽  
M. Jarecki ◽  
B. Skórka
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Plasma Renin Activity ◽  
Plasma Catecholamines ◽  
Plasma Renin ◽  
Work Load ◽  
Renin Activity ◽  
Plasma Noradrenaline ◽  
Hypertensive Patients ◽  
Control Subjects

1. The effect of physical exercise on blood pressure, plasma catecholamines and plasma renin activity was studied in fourteen patients with essential hypertension and in eight healthy subjects. 2. Resting plasma noradrenaline and adrenaline and plasma renin activity of the hypertensive patients did not differ from those of the control subjects. 3. In response to graded exercise producing successive heart rates of 120, 140 and 160 beats/min, significantly greater increases of blood pressure were found in the patients than in the control subjects. 4. Plasma noradrenaline increased significantly in both groups at all levels of exercise, the responses being significantly greater in the hypertensive patients. 5. The mean arterial blood pressure was significantly correlated with plasma noradrenaline concentration in the control subjects but not in the hypertensive patients. 6. In the hypertensive group plasma adrenaline increased significantly after exercise at all work loads whereas, in the control group, significant increase occurred only at the highest work load. The differences in the response of the two groups were significant at each work load. 7. Plasma renin activity increased significantly after exercise at the heart rate of 120 beats/min, both in the hypertensive patients and in the control subjects. The magnitude of the response was similar in the two groups.

Time Course of Systemic and Renal Plasma Prostanoid Concentrations and Renal Function in Ovine Hyperdynamic Sepsis

1994 ◽  
Vol 86 (5) ◽  
pp. 599-610 ◽  
Author(s):  
Andreas Weber ◽  
Ian M. Schwieger ◽  
Olivier Poinsot ◽  
Denis R. Morel
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Creatinine Clearance ◽  
Renal Blood Flow ◽  
Plasma Renin ◽  
Endotoxin Infusion ◽  
Group 2 ◽  
Group 1

1. We continuously recorded systemic and renal haemodynamic changes, and arterial, renal venous and urinary concentrations of thromboxane B2, 6-keto-prostaglandin F1α and prostaglandin E2, and determined their relationship to renal function in an ovine model of progressive hyperdynamic sepsis. 2. Nine chronically instrumented unanaesthetized sheep were given a continuous intravenous infusion of Escherichia coli endotoxin (20 ng min−1 kg−1) for 3 days. 3. Within the first 12 h of infusion, endotoxin induced a major hypotensive septic syndrome, including a persistent 30% reduction in mean arterial pressure, a 50% decrease in systemic vascular resistance and a 50% increase in mean pulmonary artery pressure, associated with severe lactacidaemia. 4. Renal blood flow decreased by 40%, and creatinine clearance, urine flow, and fractional sodium excretion decreased by more than 75%, of baseline values. After 12 h of endotoxin infusion, cardiac output increased two-fold and renal blood flow recovered to baseline values, whereas creatinine clearance remained depressed. Four sheep died between 13 and 22 h of endotoxaemia; these animals (allocated to group 1) presented a significantly and persistently more reduced renal blood flow (−23%) and creatinine clearance (−77%) after 4 h than the remaining five sheep (allocated to group 2), which survived more than 36 h (−16% and −21%, respectively), whereas systemic and pulmonary haemodynamic and gas exchange data remained similar in both groups. 5. The more pronounced decreases in renal blood flow, creatinine clearance and urine flow in group 1 were associated with higher plasma renin activity and plasma 6-keto-prostaglandin F1α concentrations and a lower fractional urinary excretion of 6-keto-prostaglandin F1α than in group 2, whereas plasma thromboxane B2 concentrations were similarly increased in both groups. Plasma prostaglandin E2 concentrations and urinary excretion were not notably affected by endotoxin infusion in either group. 6. Our results are not in favour of a significant renal production of any of these three prostanoids during endotoxaemia. In both groups, values of creatinine clearance were linearly correlated with simultaneous mean arterial pressure values after starting endotoxin infusion (group 1: creatinine clearance = 1.99 × mean arterial pressure −105, r = 0.95; group 2: creatinine clearance = 2.06 × mean arterial pressure −104, r = 0.80). 7. These findings indicate that during continuous endotoxin administration in sheep (1) the renal haemodynamic and functional responses are biphasic, (2) severe impairment of renal function is associated with elevated plasma renin activity and 6-keto-prostaglandin F1α plasma concentrations and with early fatality, and (3) renal filtration capacity directly depends on renal perfusion pressure, suggesting a loss of renal filtration autoregulation during endotoxaemia.

RENAL FUNCTION AND CARDIOVASCULAR RISK IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY: THE ROLE OF LEPTIN AND ADIPONEKTIN

2018 ◽  
Vol 22 (5) ◽  
pp. 51-57 ◽  
Author(s):  
M. E. Statsenko ◽  
M. V. Derevyanchenko
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Arterial Hypertension ◽  
Inverse Correlation ◽  
Cardiovascular Complications ◽  
The Body ◽  
Group 4 ◽  
Group 2 ◽  
Group 1

THE AIM:to evaluate the role of laboratory obesity markers in the progression of chronic kidney disease (CKD) and the development of cardiovascular complications in patients with arterial hypertension (AH) and obesity.PATIENTS AND METHODS. 120 patients with AH stage II-III aged  from 45 to 70 years with unachieved target blood pressure values  (BP) were divided into four comparable in sex, age, frequency of  smoking occurrence, hypertension duration, the level of office  systolic AD (SBP) and diastolic blood pressure (DBP) groups  depending on the body mass index (BMI). We performed physical  examination, evaluated the renal function, laboratory markers of  obesity, analyzed the combined risk of CKD progression and the  development of cardiovascular complications.RESULTS.There was a significant increase in the level of proteinuria (PU) and albuminuria (AU) among the patients in groups 3 and 4  compared with group 1 (301.3 [138.1, 691.0] and 305.7 [139.4,  646.9] vs 101.3 [47.9, 116.9] mg/g; 91.0 [65.9, 273.5] and 119.2  [91.0, 291.2 vs 42.2 [41.3; 51.1] mg/g, respectively), as well as a  statistically significant decrease in the glomerular filtration rate  (GFR) in patients of groups 3 and 4 compared with patients in group 1 (63,53,73 and 61,22,71 vs 72 [ 64; 98] mL / min / 1.73 m2).  Serum leptin concentration increased from group 1 to group 4 (significant differences were found between groups 2,3,4 in  comparison with group 1 and between group 4 in comparison with group 2), while the concentration of adiponectin decreased from  group 1 to group 4 (the differences were significant between groups  2,3,4 in comparison with group 1). A statistically significant inverse  correlation between GFR and leptin concentration (r = -0.42), a direct correlation between the concentration of adiponectin and GFR (r = 0.36), the inverse relationship between the concentration of adiponectin and PU (r = -0.33), AU (r = -0.24) were found.CONCLUSION.The study showed a statistically significant  progressive deterioration in the renal function, as well as an increase in the combined risk of progression of CKD and the development of  cardiovascular complications in AH patients with an increase in  obesity with comparable values of office SAP and office DAP among  the studied groups. The revealed reliable correlation interrelations  between the parameters of renal function and obesity markers  testify to the important pathogenetic role of leptin and adiponectin in the development and progression of CKD in patients with AH and obesity.

scholarly journals Hormonal aspects in the pathogenesis of arterial hypertension in young obese patients in young obese patients

1993 ◽  
Vol 39 (5) ◽  
pp. 26-28
Author(s):  
I. V. Tereschenko ◽  
N. L. Vladimirskaya
Keyword(s):  
Essential Hypertension ◽  
Arterial Pressure ◽  
Arterial Hypertension ◽  
Blood Lipids ◽  
Plasma Renin ◽  
Obese Patients ◽  
Hormonal Dysfunction ◽  
Group 2 ◽  
Early Manifestation ◽  
Group 1

Measurements of blood lipids and hormones (plasma renin, aldosterone, vasopressin, prolactin, atrial natriuretic peptide, 6-endorphine, thyrotropin, thyroid hormones) in two groups of patients suffering from obesity (group 1: 64 patients with arterial hypertension and group 2: 26 patients with normal arterial pressure) have brought the authors to a conclusion that arterial hypertension in young obese patients is an early manifestation of essential hypertension. Hormonal dysfunction in obese patients is conducive to early development of essential hypertension in cases when there is a hereditary predisposition to it.

An Early Prenatal Exposure to Excess Glucocorticoid Leads to Hypertensive Offspring in Sheep

1998 ◽  
Vol 94 (2) ◽  
pp. 149-155 ◽  
Author(s):  
M. Dodic ◽  
C. N. May ◽  
E. M. Wintour ◽  
J. P. Coghlan
Keyword(s):  
Blood Pressure ◽  
Adrenocorticotropic Hormone ◽  
Plasma Renin ◽  
Later Life ◽  
Control Group ◽  
Entire Pregnancy ◽  
Basal Plasma ◽  
Vascular Sensitivity ◽  
Group 2 ◽  
Group 1

1. Recent studies in animals have linked fetal exposure to excess maternal glucocorticoids with the later occurrence of cardiovascular disorders, particularly hypertension. 2. To test the hypothesis that prenatal treatment could impact on adult blood pressure two groups of pregnant ewes were transported from the farm to the Institute at either 22–29 days of pregnancy (pretreatment group 1) or 59–66 days of pregnancy (pretreatment group 2), subjected to 48 h treatment with dexamethasone (0.28 mg day−1 kg−1 for 2 days) and then returned to the farm. The control group remained at the farm for the entire pregnancy. Lambs were then studied at approximately 4, 10 and 19 months after birth. 3. The basal mean arterial pressure in pretreatment group 1 (80 ± 1 mmHg at 124 days; 83 ± 1 mmHg at 309 days and 89 ± 1 mmHg at 558 days; n = 6) was significantly different (P < 0.05 in all groups) from that in the control group of lambs (74 ± 2 mmHg at 110 days; 76 ± 1 mmHg at 323 days and 81 ± 1 mmHg at 568 days; n = 7). However, prenatal glucocorticoid exposure did not alter vascular sensitivity to noradrenaline, angiotensin II and adrenocorticotropic hormone in these sheep at any of the ages studied, nor did it affect basal or adrenocorticotropic hormone-induced concentrations of Cortisol or basal plasma renin concentrations in the lambs at any age. 4. These data support the hypothesis that excess glucocorticoid exposure in early pregnancy, during a critical developmental stage or ‘window’, programmes higher blood pressure that persists in later life.

To compare the haemodynamic stress response of direct laryngoscopy and oro-tracheal intubation using McCoy and Macintosh blade in general anaesthesia

2021 ◽  
Vol 12 (3) ◽  
pp. 28-32
Author(s):  
Arupratan Maiti ◽  
Sreya Moitro
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Direct Laryngoscopy ◽  
Mean Blood Pressure ◽  
Macintosh Blade ◽  
Group 2 ◽  
Group 1

Background: Direct Laryngoscopy and intubation lead to extensive stress response and sympathetic stimulation in the body which can be critical for some patient subsets like cardiac ischemia, raised intracranial tension, cerebral aneurysm, open globe injury, glaucoma etc. Hence reduction of the intense stress response is of utmost importance for a stable and safe hemodynamics in those patients. Aims and Objectives: 1. To find out the hemodynamic stress response exerted by the Macintosh blade and McCoy blade. 2. To compare the hemodynamic stress responses between the two blades. Materials and Methods: In this study we had selected 60(male and female in equal number) ASA grade-1 and grade- 2 patients posted for elective general surgery. They were randomly divided into two groups - group 1(laryngoscopy done by McCoy blade)and group 2(laryngoscopy done by Macintosh blade). Systolic Blood Pressure, Diastolic Blood Pressure , Mean Blood Pressure and Heart Rate were recorded before and after anaesthesia induction, just after intubation and one, three and six minutes after orotracheal intubation. Results: The results were compared over time between the two groups. Mean values of Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure and heart rate were significantly higher in group 2 as compared to group 1(with p values as 0.009, 0.008, 00.004 and 0.000 respectively). Conclusion: Thus we conclude that the stress response was significantly higher when laryngoscopy was done with Macintosh blade as compared with McCoy blade. We would also like to stress that the art of laryngoscopy should just not be mastered but all anaesthesiologists should think of and practise techniques which would make laryngoscopy smooth and less stressful for our patients. Intubation with McCoy laryngoscope blade is one such technique.

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