アンギオテンシンIIアナログの臨床応用 (第3報):高血圧症患者ならびに体液, 電解質異常患者におけるアンギオテンシンIIアナログ ([1-sarcosine, 8-isoleucine] Angiotensin II) 投与前後の血漿レニン活性および血漿アルドステロン値について

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Blockade of angiotensin II has been attempted by in vivo administration of angiotensin II antagonistic analogue in order to investigate the role of renin-angiotensin-aldosterone system in the maintenance of blood pressure. Preliminary studies showed that blood pressure changes were not uniform, which conceivably depends not only on the antagonistic activity but also on body fluid status, vascular reactivity, autonomic nervous system as well as the agonistic (pressor) activity of the compound per se.<BR>Herein, 1-sarcosine, 8-isoleucine angiotensin II was infused intravenously for 30 minutes at a rate of 200ng/kg/min in 45 subjects with a variety of hypertensive as well as body fluid and electrolyte disorders and changes of blood pressure (BP), plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were studied before and after the infusion. Neither of BP, PRA or PAC changes appeared uniform on the whole. Most of low-renin hyper-tensive subjects (low renin essential hypertension and primary aldosteronism) showed elevation of BP and while PRA remained unchanged. Four out of 10 high-renin hypertensive subjects showed reduction of BP and PRA and the rest showed only elevation of BP. Changes of BP and PRA of normal-renin hypertensives were quite variable. Many normotensive subjects showed elevation of PRA and more or less reduction of BP. Subjects with Bartter's syndrome and renal tubular acidosis whose vascular volume was conceivably reduced, showed the largest reduction of BP and elevation of PRA. A curvilinear relation was observed between pre-infusion PRA and percent changes of PAC.<BR>It was concluded that BP is maintained by augmented secretion of renin in disorders associated with contracted vascular volume and that, in cases of low-renin hypertensives, 1-sarcosine, 8-isoleucine angiotensin II has an agonistic effect on the adrenal cortex as well.
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