Studies on Sympathetic Nerve,Renin-Angiotensin and Renal Kallikein-Kinin Systems,and Water-Sodium Balance in Essential Hypertension

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  • Studies on sympathetic nerve, renin-angiotensin and renal kallikrein-kinin systems, and water-sodium balance in essential hypertension.
  • Studies on Sympathetic Nerve Renin Angi

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In order to clarify the relationships among sympathetic nerve, renin-angiotensin and renal kallikrein-kinin systems, and the water-sodium balance in essential hypertension, plasma noradrenaline concentration (pNA), plasma renin activity (PRA), plasma volume (PV), extracellular fluid volume (ECFV), total exchangeable sodium (Nae), urinary kinin excretion, and fractional excretion of sodium (FENa) and of inorganic phosphorus (FEP) were measured during the 4 days immediately after (the first period) and the last 4 days (the last period) of 2 weeks rest following admission with regular diet (Na;256300 mEq/day) in 209 patients with mild essential hypertension. In the first period, the resting level of pNA correlated positively with diastolic blood pressure (p < 0.02), mean arterial pressure (MAP; p < 0.05) and PRA (p < 0.001), and negatively with PV (p < 0.05), ECFV (p < 0.001) and Nae (p < 0.001), respectively. In addition, a significantly inverse correlation was found between MAP and PV (p < 0.01), ECFV (p < 0.01) and Nae (p < 0.01). Following 2 weeks rest after admission, most patients showed a spontaneous blood pressure fall. In 32 patients with MAP reduction more than 5 mmHg (average: 14mmHg), PV (p < 0.001), ECFV (p < 0.01) and Nae (p < 0.001) significantly increased, while FENa (p < 0.001) and FEP (p < 0.0 1 ) decreased after 2 weeks rest. In the last period of 2 weeks rest, no significant correlation was observed between pNA level and MAP, and MAP significantly correlated not negatively but positively with PV (p < 0.02) or Nae (p < 0.05). In all of the values obtained in both the first and the last period of 2 weeks rest, there found significantly positive correlations between pNA and FENa (p < 0.02) and 24-hour urinary excretion of kinin (p < 0.05), respectively. Moreover, urinary excretion of kinin correlated positively with FENa (p < 0.01) and negatively with PV (p < 0.01). However, follwing intravenous infusion of noradrenaline (0.1-0.2 μg/kg/min., 120 minutes), urinary sodium excretion (p < 0.01) and FENa (p < 0.05) significantly decreased and a similar tendency was found in FEP (0.05 < p < 0.1). These findings suggest that an increase of sympathetic nerve activity might be an important mechanism which maintains a high level of blood pressure, particularly, during the first period after admission in patients with mild essential hypertension. In addition, this activity might be closely related to body fluid-sodium balance, and to renin-angiotensin and renal kallikrein-kinin systems. On the other hand, after 2 weeks rest, when the sympathetic nerve activity declined the blood pressure level appeared to be more dependent on body fluid and sodium balance which might be regulated, in part at least, by sodium reabsorption in the renal tubule, including the proximal part, possibly via change in the renal kallikrein-kinin system.

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