本態性高血圧症の血圧維持機構に関する研究 : 殊に降圧利尿剤に対する反応からみた検討
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概要
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The following observations were carried out in order to clarify the role of renin-angiotensinaldosterone system and pituitary-adrenocortical system in the mechanism to maintain the blood pressure of essential hypertension. (1) ACTH was infused in 43 men with essential hypertension and 10 men with normal blood pressure (normotensive group) before and after the administration of thiazide for 2 weeks. Low, normal and high renin group of essential hypertension were classified according to plasma renin activity (PRA) after the administration of thiazide for 2 weeks. In addition, patients were divided into two groups, i. e. responder group with more than 10% reduction of mean blood pressure and non-responder group with less than 10% of mean blood pressure. (2) Thiazide and spironolactone were administered to 17 patients with essential hypertension for 2 weeks, and non-responder group were further studied about the response to SQ14225 (converting enzyme inhibitor). (3) ACTH was also infused in 11 patients with Conn's syndrome due to adenoma. (4) The relation between urinary sodium excretion for 24 hours and PRA at the time of the administration of diuretics were studied. Results ; The basal values of plasma progesterone concentration (PPC) and plasma cortisol concentration (F) and their responses to ACTH showed no significant difference among normotensive group, low, normal and high renin groups before the administration of thiazide. In the low renin group, the basal value of plasma aldosterone concentration (PAC) and response to ACTH showed no significant difference from normotensive group or normal renin group before the administration of thiazide, but 2 weeks after administration was significantly lower than those in the other two groups. The difference of the values of PRA and the responses of PAC to ACTH before and after thiazide administration was defined as △PRA and △PAC respectively. Significant relationship between LlPRA and △PAC was recognized in normotensive group (r=0.753) and in normal renin group(r=0.639) but no significant relationship was seen in high renin group (r=0.447) and in low renin group (r=-0.387). Both basal value of PAC and its response to ACTH in the group of Conn's syndrome were markedly higher than in normotensive group and every groups of essential hypertension. PRA and PAC in normotensive group and nonresponder group increased after the administration of thiazide, although PRA and P AC in the responder group increased only slightly. There was a significant relationship between the increment of PRA and the reduction of mean blood pressure(r=0.412)after the administration of thiazide and more significant relationship (r=0.697) was observed after the administration of both thiazide and spironolactone. SQ14225 resulted in the marked reduction of blood pressura and the increase of PRA without any change in PAC 30 min. after the administration. A significant relationship was found between the increment of PRA and the reduction of mean blood pressure 60 min. after the administration of SQ14225 (r=-0.791). The increment of PRA after the administration of thiazide was significantly lower in cases with urinary sodium excretion between 201 and 300 mEq/day than in cases with that between 101 to 200 mEq/day, but after the combined administration of thiazide and spironolactone, no difference was found between them. These results led to the following conclusions, (1) The abnormality of renin-angiotensin-aldosterone system recognized in low rening group. (2) The stimulation of renin-angiotensin system possibly inhibit the antihypertensive effect of diuretics. (3) The antihypertensive effect of thiazide may be influenced by a moderately increased salt intake.
- 神戸大学の論文