Effect of Volume Depletion and Subsequent Propranolol Treatment on Blood Pressure and Plasma Renin Activity in Patients with Essential and with Renovascular Hypertension

1. In nineteen patients, five with unilateral renal artery stenosis and fourteen with essential hypertension (WHO grades I–II), blood pressure, plasma and extracellular fluid volumes and plasma renin activity were studied at the end of three sequential periods: (a) after at least 3 days on a 60 mmol Na+ diet; (b) after 3 days of salt depletion induced with a diuretic and sustained on a 20 mmol Na+ diet; (c) after 3 days during which the 20 mmol Na+ diet was continued and beta-receptor blockade was induced by increasing dosages of propranolol up to 320 mg daily. 2. After sodium depletion extracellular fluid volume and plasma volume decreased and plasma renin activity increased; blood pressure did not change significantly. 3. After adding propranolol, plasma volume and extracellular fluid volume remained low, and there was a significant decrease in plasma renin activity and blood pressure. 4. No correlation could be demonstrated between changes of blood pressure and plasma renin activity. 5. When the responses of the five patients with renal artery stenosis were compared with those of the fourteen patients with essential hypertension, no significant differences were found. 6. Propranolol has a strong anti-hypertensive effect after Na+ depletion, irrespective of the absolute activities of plasma renin.

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Solitary Kidney and Ageing as Causes of Low Renin and Aldosterone Concentrations: Relevance to ‘Low-Renin’ Essential Hypertension

Clinical Science ◽

10.1042/cs051177s ◽

1976 ◽

Vol 51 (s3) ◽

pp. 177s-180s ◽

Cited By ~ 1

Author(s):

R. Gordon ◽

Freda Doran ◽

M. Thomas ◽

Frances Thomas ◽

P. Cheras

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Plasma Renin Activity ◽

Plasma Volume ◽

Plasma Renin ◽

Renin Activity ◽

Dietary Sodium ◽

Sodium Restriction ◽

Normotensive Subjects ◽

The Mean

1. As experimental models of reduced nephron population in man, (a) twelve men aged 15–32 years who had one kidney removed 1–13 years previously and (b) fourteen normotensive men aged 70–90 years were studied. Results were compared with those in eighteen normotensive men aged 18–28 years and eleven men aged 19–33 years with essential hypertension. 2. While the subjects followed a routine of normal diet and daily activity, measurements were made, after overnight recumbency and in the fasting state, of plasma volume and renin activity on one occasion in hospital and of blood pressure on five to fourteen occasions in the home. Blood pressure was also measured after standing for 2 min and plasma renin activity after 1 h standing, sitting or walking. Twenty-four hour urinary aldosterone excretion was also measured. 3. The measurements were repeated in the normotensive subjects and subjects in (a) and (b) above after 10 days of sodium-restricted diet (40 mmol of sodium/day). 4. The mean plasma renin activity (recumbent) in essential hypertensive subjects was higher than in normotensive subjects. In subjects of (a) and (b) above, it was lower than normotensive subjects, and was not increased by dietary sodium restriction in subjects of (a). 5. The mean aldosterone excretion level was lower in old normotensive subjects than in the other groups, and increased in each group after dietary sodium restriction. 6. Mean plasma volume/surface area was not different between the four groups and in normotensive, essential hypertensive and nephrectomized subjects but not subjects aged 70–90 years was negatively correlated with standing diastolic blood pressure.

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Time-course of the changes in blood pressure and in plasma renin activity during the first week after dilation of renal artery stenosis

Journal of Hypertension ◽

10.1097/00004872-198900076-00089 ◽

1989 ◽

Vol 7 ◽

pp. S186-187 ◽

Cited By ~ 1

Author(s):

Alberto Morganti ◽

Patrizia Quorso ◽

Paola Ferraris ◽

Andrea Lovaria ◽

Maria Fruscio ◽

...

Keyword(s):

Blood Pressure ◽

Plasma Renin Activity ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Time Course ◽

Plasma Renin ◽

Artery Stenosis ◽

Renin Activity

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Suppression of the Renin—Aldosterone System in Mild Essential Hypertension

Clinical Science ◽

10.1042/cs0500269 ◽

1976 ◽

Vol 50 (4) ◽

pp. 269-276

Author(s):

A. M. Khokhar ◽

J. D. H. Slater ◽

T. P. Jowett ◽

N. N. Payne

Keyword(s):

Essential Hypertension ◽

Plasma Renin Activity ◽

Extracellular Fluid ◽

Young Men ◽

Plasma Renin ◽

Fluid Volume ◽

Extracellular Fluid Volume ◽

Renin Activity ◽

Low Renin Hypertension ◽

Head Up Tilt

1. Suppression of the renin—aldosterone system by expansion of the extracellular fluid volume with extra sodium and mineralocorticoid for 6 days was studied in nine young men with very mild essential hypertension and in ten normotensive young men. 2. Plasma renin activity, measured both supine and after 45° head-up tilt, and the renal excretion of aldosterone 18-glucuronide were similar in both groups. However, after expansion of the extracellular fluid volume, hypertensive patients showed much less suppression of both variables. 3. This difference persisted despite matching for an equivalent degree of expansion of the extracellular fluid volume as indexed by the change in body weight. 4. Administration of extra sodium and mineralocorticoid produced a greater proportional fall of renal aldosterone excretion than of plasma renin activity in both groups and this dissociation was significantly more marked in the hypertensive group. 5. We suggest that (i) a relative autonomy of the renin—aldosterone system may be relevant to the pathogenesis and/or perpetuation of essential hypertension and (ii) that the syndrome of low-renin hypertension is unlikely to be associated with ‘mineralocorticoid’ excess.

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Effect of Atenolol(Tenormin®) on Blood Pressure and Plasma Renin Activity in Essential Hypertension

Korean Circulation Journal ◽

10.4070/kcj.1982.12.1.145 ◽

1982 ◽

Vol 12 (1) ◽

pp. 145

Author(s):

Soon Kyu Suh ◽

Sae Wha Yoo ◽

Soon Chang Park ◽

Joon Sock Kim ◽

Kyung Ho Kang ◽

...

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Plasma Renin Activity ◽

Plasma Renin ◽

Renin Activity

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Renal sodium handling in normal humans subjected to low, normal, and extremely high sodium supplies

AJP Renal Physiology ◽

10.1152/ajprenal.1985.249.6.f941 ◽

1985 ◽

Vol 249 (6) ◽

pp. F941-F947 ◽

Cited By ~ 8

Author(s):

J. C. Roos ◽

H. A. Koomans ◽

E. J. Dorhout Mees ◽

I. M. Delawi

Keyword(s):

Blood Pressure ◽

Plasma Renin Activity ◽

Sodium Intake ◽

Extracellular Fluid ◽

Plasma Renin ◽

Renin Activity ◽

Sodium Reabsorption ◽

Lithium Clearance ◽

Renal Sodium Handling ◽

Sodium Handling

We studied renal sodium handling, extracellular fluid volume (ECFV), plasma renin activity, aldosterone and norepinephrine, and blood pressure in eight healthy volunteers after equilibration on intakes of 20, 200, and 1,128 +/- 141 meq sodium, respectively. Renal sodium handling was assessed by means of clearance studies during maximal water diuresis and lithium clearance. Urinary sodium excretions were 22 +/- 4, 202 +/- 19, and 1,052 +/- 86 meq/day. From the lower to the upper sodium intake level, 24-h creatinine clearance rose from 111 +/- 7 to 136 +/- 11 ml/min and inulin clearance from 103 +/- 9 to 129 +/- 9 ml/min, whereas proximal and distal fractional sodium reabsorption (FSRprox and FSRdist, respectively) fell from 86.8 +/- 1.3 to 79.0 +/- 2.7% and from 96.5 +/- 0.5 to 76.0 +/- 1.9%, respectively. During the normal sodium intake (200 meq), intermediate values were recorded. The changes in fractional lithium clearance were less consistent but correlated with FSRprox (r = 0.78, P less than 0.001) and not with FSRdist. Major changes in plasma renin activity, aldosterone, and, to a lesser extent, norepinephrine accompanied these changes in kidney function, displaying inverse and exponential correlations with daily sodium excretion and ECFV. No consistent rise in blood pressure was detected. These observations indicate that in healthy humans renal adaptation to vast variations in sodium intake includes resetting of glomerular filtration rate, FSRprox, and, in particular, FSRdist. Alterations in neurohumoral factors may play a dominant role in this adaptation.

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