本態性高血圧症におけるRenin-Angiotensin-Aldosterone系の役割 : β受容体遮断薬の降圧とRenin-Angiotensin-Aldosterone系の変動
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The present study was performed to evaluate the role of the renin-angiotensin-aldosterone (R-A-A) system on the lowering effect of blood pressure of beta adrenergic blocking agent, atenolol, in 40 male patients with mild essential hypertension. These patients were treated with 50mg of atenolol, once daily, for 2 weeks : Before and after the treatment with atenolol, plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were measured after the loading with intravenous injection of 40 mg furosemide and two hours' upright posture, and the patients investigated were classified into three renin subgroups, i. e. high, normal and low renin groups. In some of the patients angiotensin I converting enzyme inhibitor, SQ 14225 was administered before one week of the biginning of the treatment with atenolol and observations were made on the changes in blood pressure, PRA and PAC for 2 hours. 1) After the administration of atenolol, a significant decrease was induced in blood pressure, PRA and PAC in high and normal renin groups, but no significnat effect was found in low renin group. 2) The fall of mean blood pressure (MBP) significantly related with the pretreatment value of resting PRA, △PRA and △PAC respectively (the variation of PRA and PAC induced by the treatment with atenolol). 3) The atenolol-induced lowering of PRA was significant in both groups of responder group (the fall of MBP was more than 10%) and non-responder group. In responder group, in addition, the significant lowering of PAC was observed. 4) A significant correlation between △PRA and △PAC was found in respeonder group alone. A significnat decrease in PAC was induced by the treatment with SQ 14225 in responder group, but no significant change was found in non-responder group. 5) Although no significant change in blood pressure was found after the treatment with atenolol in responder group, a trend of the lowering of blood pressure was demonstrated in nonresponder group following the loading with furosemide and upright posture, espesially in normal renin group it was significant statistically. From these results, it was suggested that the suppression of PAC as well as that of PRA related to the lowering mechanism of blood pressure induced by beta adrenergic blocking agent, atenolol. It was also postulated that the maintenance mechanism of blood pressure in non-responder group whose regulating mechanism of R-A-A system appeared to be impaired was mainly volume-dependent, while that in responder group with normal R-A-A system was mainly vasoconstrictor-dependent.
- 神戸大学の論文
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