Essential Hypertension: Abnormal Renal Vascular and Endocrine Responses to a Mild Psychological Stimulus
Essential Hypertension: Abnormal Renal Vascular and Endocrine Responses to a Mild Psychological Stimulus
复制标题
原发性高血压：肾血管和内分泌对轻微心理刺激的异常反应
作者：
N. Hollenberg;G. Williams;D. Adams
我们评估了轻度情绪刺激对24名正常受试者（其中8名父母患有高血压）和IS患者合并原发性高血压的动脉血压、心率、肾血流量、血浆树脂活性（PRA）和血浆醛固酮浓度的影响。一项非语言智商测试，雷文渐进矩阵，被用作刺激。15例高血压患者中有11例动脉血压短暂升高7mmhg以上，而16例正常受试者中只有3例动脉血压短暂升高（χ 2 = 7.23, p < 0.01）。短暂性中度心率升高在高血压患者中也更为常见（p < 0.01）。16例正常人中有11例肾血流量升高，15例原发性高血压患者肾血流量均下降（x*−15.1;/> < 0.005）。与动脉压和心率的短暂变化相反，肾灌注的下降是持续的。16例家族史阴性的正常受试者中有10例PRA下降，15例原发性高血压患者中有14例PRA升高（p < 0.005）。血浆血管紧张素II和醛固酮浓度的变化与PRA的变化一致，但血浆皮质醇没有变化。在高血压家族史阳性的正常受试者中，肾血管反应和PRA变化均为中等水平。全组39例受试者肾血管反应方向与PRA的方向性变化有统计学意义的一致，PRA下降时肾血流量上升，PRA升高时肾血流量下降（p < 0.005）。我们得出结论，原发性高血压患者的肾循环和肾素释放控制在心理刺激下都存在异常，并且在一些父母患有高血压的正常受试者中也存在类似的过程。
SUMMARY We have assessed the influence of a mild emotional stimulus on arterial blood pressure, heart rate, renal blood flow, plasma resin activity (PRA), and plasma aldosterone concentration in 24 normal subjects, eight of whom had a parent with hypertension, and in IS patients with essential hypertension. A nonverbal IQ test, Raven's Progressive Matrices, was employed as the stimulus. In 11 of the 15 hypertensives, arterial blood pressure rose transiently by 7 mm Hg or more, but in only three of 16 normal subjects (x 2 = 7.23, p < 0.01). Transient moderate increases in heart rate were also more common in the hypertensives (p < 0.01). Renal blood flow rose in 11 of 16 normal subjects and fell in each of the 15 patients with essential hypertension (x* − 15.1;/> < 0.005). As opposed to the transient changes in arterial pressure and heart rate, the fall in renal perfusion was sustained. The PRA fell in 10 of the 16 normal subjects with a negative family history and rose In 14 of 15 patients with essential hypertension (p < 0.005). Changes in plasma angiotensin II concentration and in plasma aldosterone were in accord with the changes in PRA, but plasma cortisol did not change. Both the renal vascular response and the change in PRA were intermediate in normal subjects in whom family history was positive for hypertension. For the entire group of 39 subjects there was statistically significant agreement between the direction of the renal vascular response and the directional change in PRA: renal blood flow rose when PRA fell and fell when PRA rose (p < 0.005). We conclude that there is an abnormality in the control of both the renal circulation and of renin release in patients with essential hypertension in response to psychological provocation, and that a similar process is present in some normotensive subjects whose parents have hypertension.