レニン非依存性本態性高血圧症における経ロアンジオテンシンI変換酵素阻害剤 (Captopril) の降圧機序

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In order to investigate the possible role of bradykinin in the hypotensive mechanism of angiotensin I converting enzyme inhibitor (Captopril) in renin-independent essential hypertension (EHT), we studied the effects of the single administration of 100 mg captopril on plasma bradykinin levels by sensitive radioimmunoassay in 21 EHT, who showed agonistic responses to 1 Sar, 8Ile-angiotensin II (A IIA). Fourteen of the patients were low renin and 7 were normal renin EHT. There was no correlation between the baseline plasma renin activity (PRA) and the fall in mean blood pressure (MBP) following captopril administration. When the patients were analyzed according to MBP response, the responders (R) showed a significantly greater bradykinin increment (_??_BK, +64%) (p<0.05), whereas the nonresponders (NR) did not show such an increase. There was a positive correlation between BK and the MBP reduction after captopril in the R group (r= 0.623, p<0.05). Plasma aldosterone (PA) decreased profoundly in the R group (-36% from baseline, p<0.05). Pretreatment ACE activity was significantly higher in the R group than in the NR group (p<0.05). Pressor response to A IIA showed a significantly (p<0.05) greater response after captopril administration in the R group. There were no significant differences in blood concentration of captopril between the R and NR groups. The present results suggest that bradykinin may be involved in the hypotensive action of captopril in the EHT subgroup, where the renin-angiotensin system appears to play an inert role for the elevation of blood pressure.
日本内分泌学会の論文

レニン非依存性本態性高血圧症における経ロアンジオテンシンI変換酵素阻害剤 (Captopril) の降圧機序

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