Pretreatment blood pressure as a predictor of 21-year mortality.

Our objective was to evaluate pretreatment predictors of longevity, particularly blood pressure, in a large cohort of hypertensive men. During 1974 to 1976, 10,367 male hypertensive veterans (47% black) were identified at screening and subsequently characterized in 32 special Veterans Administration (VA) hypertension clinics. Their mean age was 52 years and mean blood pressure (BP) 154/100 mm Hg. During an average of 21 years of follow-up, 61% died. Risk ratios for all-cause mortality as functions of BP and other risk factors are presented for each variable alone; for each variable controlling for age, race, and BP; and for a multivariate model. We observed that when the entire cohort was divided into deciles by systolic blood pressure (SBP) and by diastolic blood pressure (DBP), the risk ratios for 21-year mortality increased from lowest to highest decile by 178% for SBP and 16% for DBP. When the deciles were computed separately by age group, increases from lowest to highest decile for those less than 40 years of age were 138% for SBP and 263% for DBP. For those over 60 years, the increases were 154% and -10%, respectively. Although blacks were younger and had more severe diastolic hypertension than whites, the risk ratios were similar within each race group. Risk patterns for mean arterial pressure and pulse pressure resembled those for SBP but had smaller gradients. Survival curves for BP groups suggested constant mortality rates during follow-up. Other significant observations included decreasing mortality with increasing body mass index and increased mortality in the Stroke Belt. We concluded that pretreatment SBP strongly predicted all-cause mortality during 21-year follow-up. For the young, both SBP and DBP were strong predictors; for the elderly, only SBP was predictive.

Elevated epidermal growth factor receptor levels in hypertensive Lyon rat kidney and aorta.

1. The adult spontaneously hypertensive Lyon rats (LH strain) exhibited increased maximal epidermal growth factor (EGF) binding in freshly prepared kidney and aortic tissue membranes compared with age-matched normotensive (LN) or hypotensive (LL) strains. However, the binding affinity of the receptors to EGF was the same in all the three strains studied. These findings indicate an increased number of EGF receptors (EGFR) in the hypertensive LH strain. 2. Protein tyrosine kinase activity associated with the EGFR was also elevated in the LH strain compared with LN or LL strains, indicating that these receptors are functionally active. 3. There was a correlation between maximal EGF binding by aortic membranes and blood pressure in individual animals (r = 0.55; P < 0.001). 4. Taken together with previously reported similar findings in other models of genetic hypertension, the present results suggest a possible role for increased levels of EGFR in the development and maintenance of genetic hypertension.

Induction of high affinity epidermal growth factor binding in the aorta of Dahl hypertensive rats fed with high salt diet.

Dahl salt sensitive rats (DS) developed severe hypertension on four weeks of high salt feeding while the Dahl salt resistant rats (DR) remained normotensive under the same conditions. The specific maximal binding of epidermal growth factor (EGF) in the freshly prepared kidney membranes of high salt fed DS rats was higher than those from DR rats (5.3 +/- 1.9 vs. 1.6 +/- 0.62 fmoles/mg protein, p<0.001). Scatchard analysis of EGF binding in the kidney showed one class of receptors in the DR (K(d) = 0.75 +/- 0.05 nM) as well as in the DS rats (K(d)=0.69 +/- 0.06 nM). The EGF binding in the aortic membranes of DS rats was also high compared to DR rats (24.98 +/- 5.52 vs. 13.20 +/- 4.10 fmoles/mg protein, p < 0.001). Scatchard analysis of EGF binding in the aorta showed one class of receptors in the DR aorta with a K(d) of 0.70 +/- 0.06 nM. On the other hand, in the DS rat aorta two classes of receptors, a high affinity form (K(d)=0.05 +/- 0.01 nM) and a low affinity form (K(d)=3.5 +/- 0.3 nM) were noted. The induction of a high affinity species of EGF receptors in the aorta, appears to be a mechanism unique to the salt fed DS rats.

Early predictors of 15-year end-stage renal disease in hypertensive patients.

There has been a continuing increase in the incidence of end-stage renal disease (ESRD) in the United States, including the fraction that has been attributed to hypertension. This study was done to seek relationships between ESRD and pretreatment clinical data and between ESRD and early treated blood pressure data in a population of hypertensive veterans. We identified a total of 5730 black and 6182 nonblack male veterans as hypertensive from 1974 through 1976 in 32 Veterans Administration Hypertension Screening and Treatment Program clinics. Their mean age was 52.5 +/- 10.2 years, and their mean pretreatment blood pressure was 154.3 +/- 19.0/100.8 +/- 9.8 mm Hg. During a minimum of 13.9 years of follow-up, 5337 (44.8%) of these patients died and 245 developed ESRD. For 1055 of these subjects, pretreatment systolic blood pressure (SBP) was greater than 180 mm Hg; 901 were diabetic; 1471 had a history of urinary tract problems; and 2358 of the 9644 who were treated had an early fall in SBP of more than 20 mm Hg. We used proportional hazards modeling to fit multivariate survival models to determine the effect of the available pretreatment data and early treated blood pressure levels on ESRD. This model demonstrated the independent increased risk of ESRD associated with being black or diabetic (risk ratio, 2.2 or 1.8), having a history of urinary tract problems (risk ratio, 2.2), or having high pretreatment SBP (for SBP 165 to 180 mm Hg, risk ratio was 2.8; for SBP > 180 mm Hg, risk ratio was 7.6).(ABSTRACT TRUNCATED AT 250 WORDS)

Regional differences in mortality during 15-year follow-up of 11,936 hypertensive veterans.

Several different investigators have reported increased stroke mortality in the southeastern United States, leading to the introduction of the term "Stroke Belt." The results presented here from the Veterans Administration Hypertension Screening and Treatment Program (HSTP) demonstrate an increased all-cause mortality among hypertensive patients seen in HSTP clinics in the southeastern United States when compared with similar patients from other HSTP clinics. Several different groupings of southeastern states were examined and compared with nine states west of the Mississippi River. A total of 11,936 male veterans, 5737 of whom were black, were identified as hypertensive during 1974-1976 in 32 HSTP clinics. Their mean age was 52.4 +/- 10.4 years, and their mean pretreatment blood pressure was 153.8 +/- 19.1/100.4 +/- 9.8 mm Hg. During a minimum of 13.9 years of follow-up, 5360 (44.9%) of these patients died. Proportional hazards modeling was used to fit a basic survival model with terms representing race, age, blood pressure, smoking, and obesity. Risk was increased with higher blood pressure, age, and smoking and with lower body mass index. For 6 HSTP clinics in an 11-state Stroke Belt (defined as states with stroke mortality > 10% above the United States average), the relative risk of death was 1.226 (95% confidence interval, 1.106-1.358) when compared with 9 states west of the Mississippi River. For two different groupings of southeastern states with 10 and 8 HSTP clinics the relative risk of death was 1.231 and 1.295.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of 'stroke-belt' residence, screening blood pressure and personal history risk factors on all-cause mortality among hypertensive veterans.

OBJECTIVES: To seek regional differences within the USA in the 'all-cause mortality' of hypertensive men during the 14 years following institution of antihypertensive treatment, and to determine how other pretreatment data can be related to that all-cause mortality. DESIGN: In the mid-1970s pretreatment clinical data were collected and computerized for 5698 hypertensive veterans. Deaths during the subsequent 14 years were obtained from the Veterans Administration Beneficiary Identification and Record Location System and the National Death Index. Relationships between pretreatment data and death were sought using chi 2- and z-tests for bivariate comparisons and logistic regression for multivariate analyses. PATIENTS: Half of the 5698 previously untreated male hypertensive military veterans were Black. Their mean age was 52.3 years and mean pretreatment blood pressure was 160/104 mmHg. Additional pretreatment data included body mass index, cigarette and alcohol usage, age and self-reported comorbidities. These patients began antihypertensive treatment during 1974-1975 in 28 special Veterans Administration outpatient clinics throughout the USA. RESULTS: During the 14 years after treatment began, 2283 of these patients (40%) died. Those from the southeastern USA, i.e. in the 'Stroke Belt', were 1.32-fold more likely to die than patients living elsewhere. Other pretreatment characteristics positively related to all-cause mortality included age, systolic blood pressure, cigarette and alcohol usage, and self-reported comorbidities. Race was unrelated to mortality. CONCLUSION: All-cause mortality was increased among hypertensive subjects from the southeastern USA. The reasons for this excess mortality remain unclear. Other pretreatment characteristics were also related to mortality, but race was not.

Long-range safety and protective benefits of angiotensin-converting enzyme inhibitors for hypertension. Do we need more clinical trials?

Inhibition of the renin-angiotensin system is being applied with considerable success to the treatment of hypertension and heart failure. Angiotensin-converting enzyme (ACE) inhibitors are the only currently available agents that can achieve this objective. In general, the major therapeutic effects of these agents in the treatment of mild to moderate hypertension or of heart failure are exerted on the vascular tissue through inhibition of the renin-angiotensin system and, secondarily, of the sympathetic nervous system. When cardiovascular functional reserve is diminished and autoregulation of regional and systemic blood flow is strained, however, ACE inhibitors may affect other organ functions (heart, kidneys, and possibly brain), hormones other than the renin system, and local tissue humoral systems. The interrelations between the renin-angiotensin system and several other vasoactive systems--including circulating and locally generated tissue hormones and centrally acting neurohormonal factors--are complex and unclear. A better understanding of these mechanisms and interrelations would allow for a more rational therapeutic use of these agents. Unknown also are the clinical effects of prolonged ACE inhibition. Whether the use of ACE inhibitors can provide primary cardiorenal protection requires proof through definitive clinical trials.

Increased EGF binding and EGFR mRNA expression in rat aorta with chronic administration of pressor angiotensin II.

This study examines the changes in the mRNA expression of epidermal growth factor (EGF), EGF receptor (EGFR), platelet derived growth factor (PDGF-B), and transforming growth factor beta (TGF-beta 1) before and after sustained pressor infusion of angiotensin II (Ang II) for 4 weeks. A threefold increase occurred in the levels of EGFR mRNA (17,240 +/- 827 vs 6403 +/- 1372 units, P less than 0.01) and TGF-beta 1 mRNA (1644 +/- 584 vs 475 +/- 30 units, P less than 0.01) only in the aorta and not in the heart and kidney tissues. This increase in both of the above mRNA transcripts highly correlated (r = 0.96 and 0.92, P less than 0.01) with the elevation of blood pressure. The specific binding of 125I-labeled EGF to aortic membranes also increased (11,429 +/- 728 vs 8630 +/- 420 cpm/mg protein, P less than 0.05) with a parallel increase in the protein tyrosine kinase activity of the membranes indicating that the enhanced EGFR mRNA expression resulted in increased activity of a functional receptor. No significant changes were observed in either EGF mRNA or PDGF-B mRNA levels. These findings suggest that EGFR and TGF-beta 1 participate in the long-term progressive pressor response to Ang II and thus potentially in the progression and the maintenance of chronic hypertension.

Chimeric rats from the fusion of genetically hypertensive and normotensive rat embryos.

Structural changes in the cardiovascular musculature of the SHR during the development of hypertension appears to involve both prehypertensive hyperplastic cellular growth and hypertension induced cellular hypertrophy. The genetic factors determining these changes are not fully known, but may involve altered growth control. The role of genetic determination on the development of hypertension in the SHR was investigated by producing chimeric rats composed of a mixture of genetically homozygous SHR and normotensive cells. Preimplantation 8-cell embryos isolated from SHR and the normotensive NBR (NIH Black Wistar) rat strains were aggregated in vitro and cultured to the blastocyst stage before implantation into surrogate mothers. Chimeric rats born to the surrogate females were raised to 36-40 wks of age and the development of hypertension monitored by tail cuff pressure (BP). BP in the chimeras varied from 115 to 205 mm Hg (146 +/- 25). Heart weights were positively correlated with BP, r = 0.76, p less than 0.05, while only a marginal and non-significant correlation of aortic weight was found (r = 0.53). The renin-angiotensin system was normal in the chimeras. This model may prove useful in determining the extent of genetically mediated cellular events in the development of hypertrophy and hypertension in the SHR.

Selectively enhanced stimulation of DNA synthesis by EGF in vascular smooth muscle cells from young and adult SHR.

Aortic vascular smooth muscle cells isolated from spontaneously hypertensive rats (SHR) replicate in vitro nearly twice as fast as cells isolated from several normotensive control strains of rats. Serum-derived peptide growth factors are known to stimulate cells to enter the DNA synthetic phase of the cell cycle and subsequent mitosis. We have examined the effect of several peptide growth factors to stimulate [3H]thymidine incorporation into DNA in smooth muscle cells isolated from adult (24 wk, hypertensive) SHR and age matched normotensive NIH Black Wistar (NBR) control rats. Our results indicate that the response of the SHR cells to epidermal growth factor (EGF) is selectively enhanced compared to the control NBR cells. PDGF also stimulated DNA synthesis but no significant difference between SHR and NBR was observed. Nerve growth factor and endothelial derived growth factor were not mitotic on either cell line. Additionally, we have found that SHR cells, isolated from young early hypertensive weanling animals before a significant elevation in pressure has occurred, divide at the same rate as adult SHR cells normotensive strains. These results are consistent with the view that genetic changes affecting the cellular response to EGF may influence the development of early hypertensive hyperplasia in the SHR which in concert with other factors aggravates the later development of hypertension.

Inhibition of epidermal growth factor-mediated DNA synthesis by a specific tyrosine kinase inhibitor in vascular smooth muscle cells of the spontaneously hypertensive rat.

Aortic vascular smooth muscle cells isolated from spontaneously hypertensive rats (SHR) grow nearly twice as fast in vitro as cells isolated from several normotensive control strains of rats. We have previously shown that DNA synthesis in SHR cells from both young and adult animals in response to epidermal growth factor is selectively enhanced compared with normotensive controls, suggesting that epidermal growth factor may be at least partly responsible for the enhanced growth rate. To determine whether the enhanced DNA synthesis in response to epidermal growth factor in SHR cells is mediated via an enhanced epidermal growth factor receptor tyrosine kinase, we measured thymidine incorporation in epidermal growth factor-stimulated vascular smooth muscle cells in the presence of the highly specific tyrosine kinase inhibitor genistein. The 50% inhibitory dose (IC50) of genistein was higher for the SHR vascular smooth muscle cells than for the normotensive Wistar rat (NBR; National Institutes of Health Black rat). This suggests that the increased DNA synthesis in response to epidermal growth factor in SHR cells is a result of higher receptor tyrosine kinase activity initiating further intracellular signals.

Therapeutic tolerance, hemodynamic effects, and oral dose kinetics of dilazep dihydrochloride in hypertensive patients.

The oral dose metabolism of dilazep dihydrochloride [tetrahydro-1H-1,4-diazepine-1,4(5H)-dipropanol 3,4,5-trimethoxybenzoate] was examined in six hypertensive patients receiving a single oral dose of 600 mg of dilazep (3-3.8 mg/kg BW). Blood was collected at 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, and 24 h after administration of the dose and urine was collected for three time intervals of 0-4 h, 4-10 h, and 10-24 h. Dilazep concentrations in blood and urine were determined by high-performance liquid chromatography. Dilazep decayed monoexponentially with a mean elimination rate constant of 0.27 +/- 0.13 h-1 and a mean half-life of 3.04 +/- 1.34 h. The mean tmax of absorption was 1.40 +/- 0.82 h. With maximally tolerated chronic doses, the steady-state concentration measured at 1 week was 25.6 ng/mL in a patient receiving 300 mg daily (100 mg TID) for 3 weeks, and dilazep concentration increased with the dose in others for up to a 600-mg dose daily. Dilazep did not produce any significant changes in heart rate and blood pressure after a single oral dose or during chronic dosing. There was no correlation between blood dilazep levels and the changes in heart rate and blood pressure. In three additional patients, oral dilazep dihydrochloride titrated gradually to maximally tolerated doses (900 mg daily) failed to produce significant effects on biochemical and neurohumoral measurements, and hemodynamic parameters as well as ventricular functional indices measured by radionucleide methods. Oral dilazep administration in maximally tolerated doses is devoid of effects on blood pressure and cardiac hemodynamic function.

Long-term benefit versus risk in therapeutic blockade of the renin-angiotensin system.

Inhibitors of the renin-angiotensin system, which are promising therapeutic agents with few side effects, have measurably improved the management of many patients with primary or secondary hypertension and those with heart failure. This paper briefly reviews the emerging evidence for the potential risk associated with long-term inhibition of the renin system. The current lack of methodology for quantification of renin-angiotensin inhibition in various tissues, however, precludes firm conclusions. Preliminary evidence suggests that in functional terms, a downregulation of the renin-angiotensin system, if therapeutically successful, is safer than aggressive and longer-lasting inhibition. It has been questioned whether antihypertensive therapy 'normalizes' the structural cardiovascular changes and whether interference with the initial adaptive phase may prove detrimental. However, no specific role for renin inhibition, apart from the antihypertensive effect, has yet been defined.

University of California, Davis, conference: Mild hypertension.

Prevalence of "higher than normal" blood pressures in a community is inversely related to the magnitude of the elevation; the milder grades of elevation are far more prevalent. A multifactorially inherited tendency to develop hypertension is modulated by multiple environmental influences. Autonomic nervous and behavioral factors plausibly appear to contribute to the initiating mechanisms of hypertension; the associated hemodynamic changes and the resulting cardiovascular structural changes interact to perpetuate the process. The complex interaction of hypertension and atherosclerosis is further complicated by direct as well as secondary effects of antihypertensive drugs on atherogenesis. Attributable cardiovascular risk is generally proportional to the degree of hypertension across the entire range of elevated blood pressure; this kind of relationship holds also for normal versus subnormal blood pressure values. Pharmacologic lowering of blood pressure, however, does not confer proportional benefit. Thus, such lowering of blood pressure to normotensive levels does not reduce the risk level to that in the normotensive population. Therapeutic outcome is influenced by the interaction of blood pressure lowering, type of antihypertensive agents used, existing risk factors, and target organ damage. Benefits of lowering blood pressure in established mild hypertension (diastolic blood pressure greater than 95 mm Hg) are confirmed. Drug treatment of patients with lower diastolic blood pressure or with isolated elevations of systolic blood pressures continues to be controversial as does the choice of initial therapeutic agent(s). The large-scale experience of clinical trials encompassing the long-term risks and benefits of the drug treatment of mild hypertension is limited to the use of diuretics and adrenergic beta blockers. A variety of new and promising therapeutic agents for use as alternate choices for initial therapy needs to undergo comparative evaluation.

Saluretic and diuretic effects of antihypertensive nitrendipine monotherapy in man.

The effects of acute (single-dose) and chronic (26-day) therapy with nitrendipine on renal function were evaluated in 10 patients with mild to moderate hypertension. The patients were studied during three phases: for one week while on a constant diet containing 100 mEq of sodium and 80 mEq of potassium daily and receiving placebo, after administration of a single 20-mg oral dose of nitrendipine, and during one week of treatment with nitrendipine at 10 mg twice daily. After two weeks of outpatient treatment at 10 or 20 mg twice daily, the patients were readmitted and reevaluated while on controlled diets. Isotopic determinations of glomerular filtration rate, effective renal blood flow, blood volume, and cardiac output were made during each phase, and free water clearance and osmolar clearance following a water load were measured; during the periods of hospitalization, 24-hour urinary creatinine and electrolyte excretion were assessed. A significant decrease in blood pressure occurred during both the acute and chronic phases as compared with the placebo phase. During the first week of treatment with nitrendipine, a significant increase in urinary sodium excretion over control values was observed, with a mean deficit of 148 +/- 7 mEq (p less than 0.001); a mean weight loss of 1.0 +/- 0.1 kg during this period was also significant (p less than 0.05). No substantial changes in glomerular filtration rate, renal blood flow, blood volume, cardiac output, plasma renin activity, and levels of plasma catecholamines or urinary aldosterone from control values were noted during either the acute or chronic phases.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of volume change on circulating immunoreactive atrial natriuretic factor in rats.

The mammalian atrial hormone atrial natriuretic factor (ANF) has been shown to have potent natriuretic and diuretic actions as well as vasodilator effects when released into the circulation. To investigate how the levels of the circulating form of this peptide change with alteration of intravascular fluid volume, we measured immunoreactive ANF in the plasma of Wistar rats after acute saline load, acute furosemide treatment, and chronic water restriction. Circulating levels of immunoreactive ANF increased significantly (p less than 0.001) 1 minute after acute saline load and returned to normal levels within 5 minutes. Volume contraction induced by furosemide treatment of chronic water restriction significantly reduced the circulating immunoreactive ANF. These data indicate that acute volume expansion causes an immediate release of immunoreactive ANF into the general circulation and acute volume contraction results in a decline of circulating levels of immunoreactive ANF, which is maintained during chronic volume contraction. These results suggest that the atria detect alterations in intravascular fluid volume and respond by changing the levels of ANF acutely as well as chronically and thereby participate in the regulation of body fluids and, perhaps, of blood pressure.

Liver angiotensinogen synthesis and release during captopril treatment in sodium-depleted rats.

In vivo generation of angiotensins depends upon both plasma renin and angiotensinogen concentrations. Those factors which may influence hepatic angiotensinogen synthesis and release were examined. We have evaluated in vivo the effects of converting enzyme inhibition on several plasma renin-angiotensin system components, and, using an in vitro preparation of liver slices, we also investigated the effects of converting enzyme inhibition on the synthesis and release of hepatic angiotensinogen. Angiotensinogen concentrations were determined by two different methods. The first was an indirect enzymatic assay which measures the amount of angiotensin I liberated from plasma by an excess of renin. The second was a direct RIA that measures both angiotensinogen and its inactive residue the des-angiotensin I-angiotensinogen. The difference between the methods represents the circulating levels of des-angiotensin I-angiotensinogen. Captopril administration in sodium-depleted rats increased plasma concentrations of renin, des-angiotensin I-angiotensinogen, and angiotensin I and decreased plasma angiotensinogen concentration measured by both methods. Plasma des-angiotensin I-angiotensinogen was significantly correlated to plasma renin concentration, which suggests an increase in the consumption of angiotensinogen when the renin secretion is extremely increased. The angiotensinogen liver content and in vitro angiotensinogen release were decreased in sodium-depleted rats treated with a converting enzyme inhibitor, and these parameters were negatively correlated to in vivo plasma levels of renin, angiotensin I, and des-angiotensin I-angiotensinogen. They were positively correlated to plasma angiotensinogen concentration measured by the indirect assay. These data suggest that captopril administration during sodium depletion has two simultaneous effects: it increases angiotensinogen consumption and second, decreases angiotensinogen production and release.

Monoclonal antibodies to pig angiotensinogen recognize minor idiotypes.

We have produced monoclonal antibodies to a highly purified pig (P) angiotensinogen preparation and characterized their ability to bind [125]I-P- angiotensinogen. Lymphocytes of RBF/Dn mice immunized with P-angiotensinogen were fused with FOX-NY myeloma cells and clones were isolated by binding to [125]I-P-angiotensinogen and by an immunodot blot assay. Three of 16 clones which recognized P-angiotensinogen were characterized. Isolated monoclonal antibodies bound only 10-15% of the total [125]I-P-angiotensinogen; however, the bound counts could be displaced with unlabelled P-angiotensinogen. None of the monoclonals inhibited the cleavage of P-angiotensinogen by homologous renin, nor did they bind to the NH-terminal angiotensin I (ANG I) peptide. Little or no binding was detected to angiotensinogens in human, monkey, rat, rabbit, sheep or bovine serum. Mixtures of the clones and analysis of the immune complexes by PAGE indicated that different binding sites on different P-angiotensinogen were detected by some of the monoclonals, while the same or competing sites were recognized by others. No combination of clones tested significantly increased the amount of P-angiotensinogen bound. We interpret these findings to indicate that monoclonal antibodies to 'purified' pig P-angiotensinogen recognize species-specific minor epitope subsets of the protein, but not antigenic determinants common to all.

Renin substrate and the renin-angiotensin system in hog tissues.

The individual components of the renin-angiotensin system has been identified in numerous tissues. In this study we have examined whether a functional renin-angiotensin system is operative in several hog tissues including brain, aorta, and liver. The contribution of tissue renin substrate to the rate of local angiotensin generation was also assessed. Electrophoretic differences in plasma and tissue renin substrates, indicating structural differences, were employed as an index of independence of the tissue system from that of the peripheral circulation. Our results indicate that all tissues studied had the potential to locally generate angiotensin and that renin substrate limited to rate of the renin reaction in these tissues. Electrophoretic parameters, polyacrylamide gel electrophoresis, and isoelectric focusing suggest that the tissue renin systems are of local origin. The potential magnitude of local angiotensin production is such that tissue renin-angiotensin systems may significantly contribute to the control and regulation of blood pressure and other regulatory mechanisms influenced by angiotensin.