高血壓症と腎機能(第7報) : 臨床的研究 : 本態性高血壓症及高血壓症とATP-ATPase系に關する臨床的觀察

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IV) ESSENTIAL HYPERTENSION Renal Function studies (especially renal clearance technique) in essential hypertension have been reported by many investigators. They generally agree that the renal blood flow is within the normal range in many individuals.The author studied the renal functions in 128 patients with essential hypertension. Renal blood flow was reduced in 74 patients (58%). The relationship between renal function and age was as follows : Below the age of 20 years, renal functions were over normal, at the age of 21-30 they were almost near mean normal, and over 31 years they were decreased with the age but the decrease was greater than in normal individuals. Most of the patients with malignant hypertension (primary or secondary) were from 31 to 50 years old.The findings of eyeground examination were compared with renal blood flow. It was found that a correlation existed between renal blood flow and eyeground changes (according to the classification of Keith-Wagener). One of the 17 cases that showed grade I eyeground changes died of cerebral hemorrhage. None of the patients with grade II eyeground changes died. 4 of 18 patients who showed grade III eyeground changes died; 2 patients had renal insufficiency and 2 patients had cerebral hemorrhage. 8 of 10 patients with grade IV eyeground changes died; 3 had renal insufficiency, 2 had cerebral hemorrhage and 3 had heart failure.Furthermore, a relationship between renal blood flow and electrocardiogram was observed. In general, there was parallelism between the myocardial damage and the reduction of renal blood flow.In patients with markedly decreased renal blood flow, it was difficult to decrease the blood pressure by rest, salt restriction or one anti-hypertensive drug, and it was necessary to administer two or more anti-hypertensive drugs.V) ATP-ATPASE SYSTEM According to Maekawa's postulation, the "true cause" of hypertension is the disturbances of ATP-ATPase system, especially the one present in the kidney which releases its ATPase into blood stream.Intravenous injection of ATPase in man could not be performed. Therefore, in this study, the effects of adenosine triphosphate on circulatory hemodynamics were observed, instead.Vasodilatation occurred with increased effective renal blood flow which was measured by PAH clearance. In 3 patients (2 with essential and 1 with renal hypertension), effects of adenosine triphosphate were studied. When 40-48mg ATPNa_4 was injected intravenously, blood pressure decreased markedly and renal blood flow increased during injection in all cases, with a tendency to return to normal during the recovery period. The thiosulfate clearance was increased, too. FF decreased in 1 out of 3 patients and urine flow increased generally.One patient suffering from renal insufficiency in chronic glomerulonephritis was treated with adenosine triphosphate. Under this treatment the blood NPN concentration decreased temporarily, the urine flow increased and the general condition of the patient became better. But at the end, in spite of increased doses of adenosine triphosphate, the patient died. It is assumed that ATPase decreases when reacting with ATP, and that the resulting fall in blood pressure is due to the diminution of ATPase, which is thought to be a pressor substance. Or it is assumed that the depressor effect of ATP is brought about by mere pharmacologic effects on blood vessels or by energysupply of ATP for dilatation of vessels.
社団法人日本循環器学会の論文
1958-11-20

高血壓症と腎機能(第7報) : 臨床的研究 : 本態性高血壓症及高血壓症とATP-ATPase系に關する臨床的觀察

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