HORMONAL AND RENAL EFFECTS OF ATRIAL NATRIURETIC PEPTIDE IN PATIENTS WITH SECONDARY HYPERTENSION
HORMONAL AND RENAL EFFECTS OF ATRIAL NATRIURETIC PEPTIDE IN PATIENTS WITH SECONDARY HYPERTENSION
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DOI：
10.1161/01.cir.78.6.1401
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发表时间：
1988-12-01
期刊：
影响因子：
37.8
通讯作者：
MATSUO, H
中科院分区：
文献类型：
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作者：
HIRATA, Y;ISHII, M;MATSUO, H
为了研究心房钠尿肽 (ANP) 在继发性高血压中的作用，我们检查了 27 名肾实质高血压患者、10 名原发性醛固酮增多症患者、8 名肾血管性高血压患者和 15 名血压正常受试者对 ANP 输注 (0.025 μg/kg/min) 的激素和肾脏反应。肾实质高血压患者（120 pg/ml，p < 0.01）和原发性醛固酮增多症患者（98 pg/ml，p < 0.05）输注前 ANP 血浆浓度显着高于血压正常受试者（40 pg/ml），但不高于肾血管性高血压患者（73 pg/ml，NS）。在肾实质高血压患者中，血浆 ANP 与肌酐清除率呈负相关（r = 0.76，p < 0.001）。在 ANP 输注期间，四组的平均血压（-5%，p < 0.01）和血浆醛固酮（-40%，p < 0.001）下降程度相似。然而，高血压患者中 ANP 引起的尿钠排泄量增加高于血压正常患者（+250% vs. 70%，p < 0.01），并且与 ANP 输注期间的平均血压呈正相关（r = 0.47，p < 0.001）。原发性醛固酮增多症患者腺瘤的切除显着降低了ANP和环鸟苷2'',3''-单磷酸的血浆水平，并减少了ANP输注期间钠排泄的增加，而血压和血浆醛固酮对ANP输注的反应并未因手术而改变。因此，这些结果表明，ANP 分泌增加和对 ANP 的利尿钠反应增加可能会改变某些类型继发性高血压的血压和体液容量状态。
To investigate the involvement of atrial natriuretic peptide (ANP) in secondary hypertension, we examined hormonal and renal responses to ANP infusion (0.025 .mu.g/kg/min) in 27 patients with renal parenchymal hypertension, 10 with primary aldosteronism, 8 with renovascular hypertension, and 15 normotensive subjects. The preinfusion plasma concentration of ANP was significantly higher in patients with renal parenchymal hypertension (120 pg/ml, p < 0.01) and in patients with primary aldosteronism (98 pg/ml, p < 0.05) than in the normotensive subjects (40 pg/ml), but it was not greater than in the patients with renovascular hypertension (73 pg/ml, NS). In the patients with renal parenchymal hypertension, plasma ANP correlated negatively with creatinine clearance (r = 0.76, p < 0.001). Mean blood pressure (-5%, p < 0.01) and plasma aldosterone (-40%, p < 0.001) decreased to a similar degree in the four groups during ANP infusion. However, an increase in urinary sodium excretion caused by ANP was higher in the hypertensive than in the normotensive patients (+250% vs. 70%, p < 0.01) and correlated positively with mean blood pressure during ANP infusion (r = 0.47, p < 0.001). The removal of adenomas in the patients with primary aldosteronism significantly lowered both plasma levels of ANP and cyclic guanosine 2'', 3''-monophosphate and reduced an increase in sodium excretion during ANP infusion, whereas the responses of blood pressure and plasma aldosterone to ANP infusion were not altered by the operation. Thus, these results suggest that elevated ANP secretion and increased natriuretic responses to ANP may modify the blood pressure and body fluid volume status in some types of secondary hypertension.