Dissociation in the Excretion of Different Aldosterone Metabolites and Unmetabolized (‘Free’) Aldosterone in Hypertension

1979 ◽  
Vol 57 (5) ◽  
pp. 409-414 ◽  
Author(s):  
S. Abdelhamid ◽  
P. Vecsei ◽  
D. Haack ◽  
K.-H. Gless ◽  
D. Walb ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Plasma Renin Activity ◽  
Plasma Renin ◽  
Renin Activity ◽  
Primary Hyperaldosteronism ◽  
Morphological Abnormality

1. The determination of aldosterone-18-glucuronide (pH 1-labile aldosterone) was complemented by concomitant measurements of free urinary aldosterone and tetrahydroaldosterone in 307 patients, most of whom were hypertensive. In 38 cases (12·3%) the normal, aldosterone-18-glucuronide concentration was clinically misleading, but increased free aldosterone and/or tetrahydroaldosterone values suggested the presence of hyperaldosteronism, which in many of these cases was confirmed by elevated excretion of the possible major aldosterone precursor 18-hydroxycorticosterone (18-OH-B). 2. Of 224 patients with essential hypertension and normal or low plasma renin activity 18 had an elevated free aldosterone and/or tetrahydroaldosterone excretion without increased aldosterone-18-glucuronide. These cases may represent early or pre-symptomatic forms of primary hyperaldosteronism. In other cases, particularly when tetrahydroaldosterone was increased alone, abnormalities of aldosterone metabolism were suspected. 3. In two out of 15 patients with primary hyperaldosteronism, aldosterone-18-glucuronide values were frequently found to be normal, although elevations were noted in other variables. However, no relation to the morphological abnormality (adenoma versus hyperplasia) was seen.

Dependence of plasma renin activity on prostaglandin excretion in essential hypertension

1978 ◽  
Vol 102 (1) ◽  
pp. 120-122 ◽  
Author(s):  
Pauli Yuitalo ◽  
Heikki Vapaatalo ◽  
Timo Metsä-Ketelä ◽  
Timo Pitkäjärvi
Keyword(s):  
Essential Hypertension ◽  
Plasma Renin Activity ◽  
Plasma Renin ◽  
Renin Activity

Diuretics in hypertension

1975 ◽  
Vol 13 (26) ◽  
pp. 101-103
Keyword(s):  
Essential Hypertension ◽  
Plasma Renin Activity ◽  
Thiazide Diuretic ◽  
Mild Hypertension ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Plasma Renin ◽  
Renin Activity ◽  
Thiazide Diuretics ◽  
Treatment Of Hypertension

Thiazide diuretics such as bendrofluazide and chlorothiazide have been used for nearly 20 years in the treatment of hypertension. They have been regarded as rather weak antihypertensive agents which could be used alone only in mild hypertension and otherwise as adjuvants to more potent drugs in more serious cases.1 There are however some patients with ‘essential’ hypertension who are very sensitive to diuretics and in whom the pressure may be brought down to normal by a thiazide2 or spironolactone3 even when it is initially considerably raised. Furthermore a few patients who are responsive to thiazides are strikingly unresponsive to non-diuretic antihypertensive drugs. Patients particularly likely to respond to a thiazide diuretic4 or spironolactone3 commonly have low plasma renin activity and this occurs in about 25% of patients with essential hypertension.5 Since plasma renin activity is not routinely estimated it is simplest to identify these patients by observing the response to an adequate trial of a thiazide.

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

1976 ◽  
Vol 51 (s3) ◽  
pp. 177s-180s ◽  
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.

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

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

Are Racial Differences in Essential Hypertension Due to Different Pathogenetic Mechanisms?

1978 ◽  
Vol 55 (s4) ◽  
pp. 383s-386s ◽  
Author(s):  
P. S. Sever ◽  
W. S. Peart ◽  
T. W. Meade ◽  
I. B. Davies ◽  
D. Gordon ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Plasma Renin Activity ◽  
Racial Differences ◽  
Plasma Renin ◽  
Urinary Sodium Excretion ◽  
Renin Activity ◽  
Plasma Noradrenaline ◽  
Noradrenaline Concentration ◽  
Blacks And Whites ◽  
Made In

1. Plasma noradrenaline concentration and plasma renin activity were measured in a control, British, urban population (n = 115) in which blacks were matched for age and sex with whites. 2. Similar measurements were made in subjects with essential hypertension (77 white and 23 black), and 48 healthy normotensive white civil servants. 3. In controls blood pressure was significantly higher in blacks; it correlated with age in both races and with pulse rate in blacks. There were no significant racial differences in plasma noradrenaline which was positively correlated with age in both blacks and whites. Mean plasma renin activity was 55% lower in blacks, and this difference was not related to urinary sodium excretion. 4. In hypertensive subjects plasma noradrenaline positively correlated with age in blacks. This relationship was not found in whites in whom 20% of young hypertensive subjects (<45 years) had significantly raised plasma noradrenaline. Plasma renin activity was again significantly lower in blacks. In white hypertensives plasma noradrenaline and renin activity were significantly correlated. 5. There may be racial differences in the pathogenesis of essential hypertension.

scholarly journals Estimation of the efficacy of the measurement of plasma renin activity and direct renin in diagnostics of primary aldosteronism

2012 ◽  
Vol 58 (5) ◽  
pp. 21-27
Author(s):  
N P Goncharov ◽  
G S Kolesnikova ◽  
G V Katsiia ◽  
E Iu Rogal'
Keyword(s):  
Plasma Renin Activity ◽  
Primary Aldosteronism ◽  
Plasma Renin ◽  
Pressure Control ◽  
Renin Activity ◽  
Differential Diagnostics ◽  
Control Groups ◽  
Aldosterone Level ◽  
Renin Level

The objective of the present study was to estimate the informative value of the measurements of aldosterone level, direct renin, and plasma renin activity as well as the relationships between these characteristics for differential diagnostics of various forms of hypertension and, first and foremost, of primary aldosteronism. We have examined a total of 162 patients. The results of differential tests were used to allocate them to a few groups including 41 patients presenting with primary aldosteronism, 52 ones with incidentalomas, 26 with essential hypertension, and 43 with various endocrine diseases and normal arterial pressure (control groups). The aldosterone levels, direct renin, and plasma renin activity were measured in blood samples taken in morning hours from the patients in the supine position. The aldosterone to plasma renin activity (A/PRA) and aldosterone to direct renin (A/DR) ratios were calculated. The elevated blood aldosterone level is currently believed to be the principal criterion for primary aldosteronism in the patients suffering arterial hypertension. The RIA technology is the method of choice for the measurement of aldosterone levels. The determination of the A/PR ratio significantly improves the detectability of the disease. The use of direct renin level instead of kinetic renin ensures the high efficacy of screening for primary aldosteronism and its early diagnostics. The cut-off point for the calculation of the A/PRA ratio to differentiate between primary aldosteronism and incidentalomas is 2160 pmol/mcg/hr (sensitivity 100%, specificity 97.8%) in comparison with the analogous cut-off point for the discrimination between primary aldosteronism and endocrine pathology without hypertension is 49 pmol/mU (sensitivity 100%, specificity 95%). The cut-off point for the calculation of the A/PR ratio to differentiate between primary aldosteronism and incidentalomas is 2160 pmol/mcg/hr (sensitivity 89.5%, specificity 99%) in comparison with the analogous cut-off point for the discrimination between primary aldosteronism and endocrine pathology without hypertension is 1432 pmol/mcg/hr (sensitivity 89.5%, specificity 100%). It is concluded that the results of determination of direct renin level in the blood plasma are independent of the endogenous angiotensinogen level, less variable and more reproducible than than the results of the measurement of plasma renin activity. The aldosterone to direct renin ratio may be used for the screening of primary aldosteronism.

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