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Renin-hyporesponsiveness in essential hypertension dissociation between plasma renin and catecholamines or aldosterone following furosemide

Verminderte Stimulierbarkeit von Renin bei essentieller Hypertonie Dissoziation zwischen Plasma-Renin und Katecholaminen oder Aldosteron nach Furosemid

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Zusammenfassung

Bei 26 Normalpersonen und 45 Patienten mit grenzwertiger (N=20) oder etablierter (N=25) essentieller Hypertonie wurden die Effekte einer sequentiellen Stimulation mittels aufrechter Körperhaltung und furosemid-induzierter Natrium-Depletion auf die Blutspiegel von Noradrenalin, Adrenalin, Dopamin, Renin und Aldosteron untersucht. Die basalen 24 h-Exkretionsraten von Natrium, Noradrenalin und Adrenalin, die basalen (liegend) Plasma-Katecholamin-, -Renin und -Aldosteronspiegel, sowie der Körpernatrium-Volumen-Status waren bei den 3 Gruppen vergleichbar. Der Wechsel zur aufrechten Körperhaltung während 10 bzw. 60 min bewirkte eine signifikante Erhöhung von Plasma-Noradrenalin (P<0,001), -Adrenalin (P<0,001) und -Dopamin (P<0,05). Die in aufrechter Haltung gemessenen Plasma-Katecholamin-Konzentrationen waren bei normalen und hypertensiven Personen vergleichbar und wurden durch die Gabe von Furosemid nicht mehr weiter verändert. Im Gegensatz dazu bewirkte sowohl die Einnahme der aufrechten Haltung als auch Furosemid einen sukzessiven signifikanten (P<0,02) Anstieg der Plasma-Renin und -Aldosteron-Werte. Die furosemid-stimulierte Renin-Aktivität war bei Patienten mit etablierter essentieller Hypertonie signifikant (P<0,05) niedriger als bei Normalpersonen oder Patienten mit Grenzwert-Hypertonie. Die furosemid-stimulierten Plasma-Aldosterone-Spiegel waren dagegen bei den drei Gruppen vergleichbar. Diese Befunde weisen darauf hin, daß die furosemid-induzierte Renin-Sekretion nicht durch eine erhöhte adrenerge Aktivität vermittelt wird. Somit kann die verminderte Stimulierbarkeit von Renin bei etablierter essentieller Hypertonie nicht durch eine erniedrigte sympathische Aktivität erklärt werden. Im Gegensatz zur gestörten Renin-Regulation scheinen sowohl die Stimulierbarkeit von Aldosteron wie auch die adrenerge Aktivität bei aufrechter Körperhaltung und nach Furosemid-Applikation bei grenzwertiger oder etablierter essentieller Hypertonie meist normal zu sein.

Summary

The influences of sequential stimulation with upright posture and sodium depletion by intravenous furosemide on blood levels of norepinephrine, epinephrine, dopamine, renin and aldosterone was studied in 26 normal subjects and 45 patients with borderline (N=20) or established (N=25) essential hypertension. Basal 24-h urinary sodium, norepinephrine and epinephrine excretion rates and basal (supine) plasma catecholamine, renin and aldosterone levels and the body sodium-volume state were comparable between the three groups. Assumption of the upright posture for 10 to 60 min caused significant increases in plasma norepinephrine (P<0.001), epinephrine (P<0.001) or dopamine (P<0.05) levels. Upright plasma catecholamine concentrations were similar in normal and hypertensive subjects and they were not modified further by furosemide. In contrast upright posture as well as furosemide induced each a successive significant (P<0.02) increase in plasma renin and aldosterone levels. Furosemide-stimulated renin was significantly (P<0.05) lower in patients with established hypertension than in normal or borderline hypertensive subjects; however, plasma aldosterone levels were comparable. These findings suggest that renin release induced by furosemide is not mediated by increased adrenergic activity. Consequently, renin-hyporesponsiveness in established hypertension cannot be explained by decreased sympathetic activity. In contrast to the altered renin regulation, aldosterone-responsiveness to upright posture or furosemide as well as adrenergic activity under these conditions appear to be usually normal in borderline or established hypertension.

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Authors and Affiliations

  1. Medizinische Poliklinik, University of Berne, Switzerland

    C. Beretta-Piccoli,  P. Weidmann, G. Keusch, M. Grimm, A. Meier, Z. Glück & W. H. Ziegler

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  1. C. Beretta-Piccoli
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  2. P. Weidmann
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  3. G. Keusch
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  4. M. Grimm
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  5. A. Meier
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  6. Z. Glück
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  7. W. H. Ziegler
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Supported by the Swiss National Science Foundation

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Beretta-Piccoli, C., Weidmann, P., Keusch, G. et al. Renin-hyporesponsiveness in essential hypertension dissociation between plasma renin and catecholamines or aldosterone following furosemide. Klin Wochenschr 58, 457–465 (1980). https://doi.org/10.1007/BF01476800

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