Renal response to captopril reflects state of local renin system in healthy humans

被引:25
作者
Fisher, NDL
Price, DA
Litchfield, WR
Williams, GH
Hollenberg, NK
机构
[1] Brigham & Womens Hosp, Div Endocrine Hypertens, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Boston, MA 02115 USA
关键词
angiotensin II; renal circulation; sodium; angiotensin converting enzyme inhibition; angiotensinogen; hypertension; vasoconstriction;
D O I
10.1046/j.1523-1755.1999.00579.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background. Heightened activity of the renin-angiotensin system has been linked to the development of both essential hypertension and diabetic nephropathy. Blunting of the renal vasoconstrictor response to Ang II, specifically when it is corrected by angiotensin converting enzyme (ACE) inhibition, is a feature which we have employed as a marker for activation of the intrarenal RAS. In this study we tested the hypothesis that variation in the renal vasodilator response to ACE inhibition in healthy humans reflected the variation in angiotensin-mediated renal vasoconstriction provoked by a low-salt diet. Methods. We studied 20 healthy people (ages 19 to 57; 15 males) who were in balance on a low sodium diet. Ang II was infused for 45 minutes (3 ng/kg/min), followed by 25 mg captopril and a repeat Ang II infusion; PAH clearance was measured at the end of each interval. Results. All subjects responded to captopril with a rise in renal plasma flow (range 43 to 242, mean 118 + 12 ml/min/1.73 m(2)). Individual vasodilator response to captopril was a strong inverse predictor of the precaptopril vasoconstrictor response to Ang II (P = 0.006, r = -0.59). There was a stronger, positive correlation of the vasodilator response to captopril and enhancement of Ang II responsiveness after captopril (r = 0.57). Plasma renin activity was significantly correlated with captopril response among the large responders (P = 0.003; r = 0.83), but not at all among those with little response. Conclusion. These results suggest substantial variation in angiotensin-mediated control of the renal circulation in healthy individuals on a low sodium intake. Variation in the vasodilator response to captopril, correlated with responses to Ang II, provides a measure of that control.
引用
收藏
页码:635 / 641
页数:7
相关论文
共 26 条
[1]   A COMPARISON OF ENALAPRIL WITH HYDRALAZINE ISOSORBIDE DINITRATE IN THE TREATMENT OF CHRONIC CONGESTIVE-HEART-FAILURE [J].
COHN, JN ;
JOHNSON, G ;
ZIESCHE, S ;
COBB, F ;
FRANCIS, G ;
TRISTANI, F ;
SMITH, R ;
DUNKMAN, WB ;
LOEB, H ;
WONG, ML ;
BHAT, G ;
GOLDMAN, S ;
FLETCHER, RD ;
DOHERTY, J ;
HUGHES, CV ;
CARSON, P ;
CINTRON, G ;
SHABETAI, R ;
HAAKENSON, C .
NEW ENGLAND JOURNAL OF MEDICINE, 1991, 325 (05) :303-310
[2]   Autonomy of the renin system in type II diabetes mellitus: Dietary sodium and rectal hemodynamic responses to ACE inhibition [J].
DeOliveira, JM ;
Price, DA ;
Fisher, NDL ;
Allan, DR ;
McKnight, JA ;
Williams, GH ;
Hollenberg, NK .
KIDNEY INTERNATIONAL, 1997, 52 (03) :771-777
[3]  
DORIA A, 1994, DIABETES, V43, P384
[4]   TISSUE ANGIOTENSIN SYSTEM IN CARDIOVASCULAR MEDICINE - A PARADIGM SHIFT [J].
DZAU, VJ ;
RE, R .
CIRCULATION, 1994, 89 (01) :493-498
[5]  
EMANUEL RL, 1973, J LAB CLIN MED, V81, P632
[6]   ANGIOTENSIN-I CONVERTING ENZYME [J].
ERDOS, EG .
CIRCULATION RESEARCH, 1975, 36 (02) :247-255
[7]   RESPONSES TO CONVERTING-ENZYME AND RENIN INHIBITION - ROLE OF ANGIOTENSIN-II IN HUMANS [J].
FISHER, NDL ;
ALLAN, D ;
KIFOR, I ;
GABOURY, CL ;
WILLIAMS, GH ;
MOORE, TJ ;
HOLLENBERG, NK .
HYPERTENSION, 1994, 23 (01) :44-51
[8]   SODIUM-INTAKE AND RENAL RESPONSES TO CAPTOPRIL IN NORMAL MAN AND IN ESSENTIAL-HYPERTENSION [J].
HOLLENBERG, NK ;
MEGGS, LG ;
WILLIAMS, GH ;
KATZ, J ;
GARNIC, JD ;
HARRINGTON, DP .
KIDNEY INTERNATIONAL, 1981, 20 (02) :240-245
[9]   RENAL CIRCULATION AND BLOCKADE OF THE RENIN-ANGIOTENSIN SYSTEM - IS ANGIOTENSIN-CONVERTING ENZYME INHIBITION THE LAST WORD [J].
HOLLENBERG, NK ;
FISHER, NDL .
HYPERTENSION, 1995, 26 (04) :602-609
[10]   SPECIFICITY OF RENAL VASODILATION WITH CAPTOPRIL - SAPALASIN PREVENTS THE RESPONSE IN THE DOCA-TREATED, SALT-LOADED RABBIT [J].
HOLLENBERG, NK ;
PASSAN, DR .
LIFE SCIENCES, 1982, 31 (04) :329-334