本態性高血圧患者におけるMg静脈内投与時の血行動態,腎水・電解質代謝,renin-angiotensin-aldosterone系,血漿副甲状腺ホルモンの変動について
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This study aimed to elucidate the effects of intravenously infused magnesium (Mg) on hemodynamics, the renal water-electrolytes metabolism,the renin-angiotensin-aldosterone system and the plasma parathyroid hormone (PTH) level in essential hypertension. Ten percent magnesium sulfate (initial dose: 13.5mg of Mg/m2・BSA/15 min; maintenance dose: 2.7mg of Mg/m2・BSA/105 min) was administered in 14 patients with essential hypertension (EHT) and in 8 normotensive subjects (NT). After the Mg infusion, significant increases of serum Mg (sMg), urine volume (UV), urinary excretions of sodium (UNa V) and calcium (UCa V), fractional excretions of sodium (FENa) and calcium (FECa), and a significant decrease of PTH were observed in both NT and EHT. Neither group showed any significant change in mean arterial pressure (MAP), heart rate, plasma renin activity (PRA) or urinary excretion of potassium (UKV). On the other hand, fractional excretion of potassium (FEK) and plasma aldosterone concentration (PAC) decreased significantly and creatinine clearance (C cr) tended to increase only in EHT. Although there was no significant difference between NT and EHT in the changes of sMg, Ccr (△Ccr), PTH (△PTH), PRA (△PRA) or PAC (△PAC), the changes of UNa V (△UNa V), UCa V (△UCa V), FENa (△FENa) and FECa (△FECa) were greater in EHT. A significant positive correlation ?was found between △UNaV and △FENa, and between △UcaV and △FEca in NT and EHT. A similar tendency was observed between △Ccr and △UNaV or △UcaV in both groups. There were significant negative correlation between △FENa and basal sMg and a positive correlation between △UNaV and △UcaV in EHT but not in NT. However, there was no significant correlation of △UNaV with △PRA or △PAC or of △UcaV with △PTH in either group. Thus, it is concluded that the intravenous administration of magnesium enhances natriuresis and calciuresis by attenuating renal tubular reabsorption of these cations in EHT. This attenuation might relate mainly to renal hemodynamic change and partly to the suppression of PAC and of plasma PTH. The enhanced natriuretic and calciuretic responsiveness to Mg might contribute to the hypotensive mechanism of long-term administration of Mg in EHT, and strongly implies the existence of an abnormal Mg metabolism in EHT.
- 1995-12-01
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