Plasma human atrial natriuretic peptide, endothelin-1, aldosterone and plasma-renin activity in pregnancy-induced hypertension.

OBJECTIVE: To determine the relationship between endothelin-1 (ET-1), human atrial natriuretic peptide (hANP), plasma-renin activity (PRA) and 24-h urinary excretion of aldosterone (U-Ald) in pregnancy-induced hypertension (PIH). DESIGN AND METHODS: Plasma hANP (pg/ml), ET-1 (pg/ml), PRA (ng/ml per h) and U-Ald (microg/24 h) were measured and 24 h ambulatory mean arterial pressure (MAP) was monitored in 178 normotensive subjects (NT) and 79 gravidas with PIH at the 8th, 18th, 23rd, 28th, 32nd and 36th weeks. RESULTS: The PIH group had higher MAP than the NT group from the 23rd week (91.64 +/- 8.76 versus 83.48 +/- 4.36 mmHg, P< 0.01) until the end of the pregnancy. ET-1 levels (pg/ml) in both groups were identical at the beginning of pregnancy and different in the 23rd week [(NT versus PIH) (35.11 +/- 17.42 and 40.2 +/- 19.51, respectively, P < 0.05)] and the 36th week (37.36 +/- 18.07 and 42.7 +/- 16.43, P< 0.05). hANP levels (pg/ml) in the NT group decreased insignificantly from the 8th till the 32nd week, then increased to 101.94 +/- 17.4 in the 36th (P< 0.001 versus any other week). In the PIH group, hANP increased from 104.8 +/- 26.8 pg/ml at the 8th week to 161.3 +/- 28.6 pg/ml at the 36th week (P< 0.0001). hANP correlated with MAP in the NT group (r = 0.252, P< 0.0005) but not the PIH group. U-Ald in the NT group increased from 23.52 +/- 6.83 microg/24 h at the 8th week to 54.07 +/- 19.62 microg/24 h at the 36th week (P < 0.0001) and in the PIH group it increased from 27.90 +/- 11.6 to 53.66 +/- 20.4 microg/24 h (P< 0.0001). In the PIH group, PRA was lower compared with the NT group from the 8th (2.99 +/- 1.26 versus 4.10 +/- 1.82 ng/ml per h, P< 0.05) until the 36th week (3.34 +/- 2.16 versus 4.46 +/- 2.13 ng/ml per h). In the forced multiple regression analysis model with hANP as a dependent variable, a value of P< 0.003 was found with PRA, U-Ald and MAP, which indicates an interaction between the two vasoactive and homeostatic systems: the renin-angiotensin-aldosterone system and hANP. CONCLUSIONS: In PIH, elevated hANP might be important as a counterbalance to the presence of the active vasopressors and sodium retention. By inhibiting renin release, enhancing the transcapillary fluid migration and with its action as vasodilator, it acts as a corrective factor of the imbalance between the contracted circulating fluid volume and the vasoconstricted vascular bed.

Renal dysfunction and early differences in twenty-four-hour ambulatory blood pressure monitoring in subjects predisposed for essential hypertension.

In 24 young normotensive subjects (mean age 22.25 +/- 5.65 years) with one hypertensive parent (FH(+)-), 22 subjects (mean age 23.55 +/- 5.17 years) with two hypertensive parents (FH+ +/-), and a control group of 16 age and gender matched subjects (mean age 22.50 +/- 6.00 years) with two normotensive parents (FH--), creatinine clearances and microalbuminuria (MA) were measured. Blood pressure was monitored for 24 hours and mean arterial pressure (MAP) was calculated and compared between groups. No significant differences were recorded. FH(+)- and FH++ subjects had significantly higher MAP over the sleeping period than FH-- subjects (78.63 +/- 1.71, 78.95 +/- 1.27; and 72.91 +/- 1.35 mmHg respectively; p < 0.02). Creatinine clearance was higher in FH(+)- and FH++ group compared to FH-- subjects (2.39 +/- 0.17; 2.29 +/- 0.17; and 1.66 +/- 0.11 ml/sec respectively; p < 0.01). Hyperfiltration correlated with MAP in FH++ subjects (2.29 +/- 0.17 ml/sec; 92.45 +/- 7.39 mmHg; r = 0.52 i p < 0.03). MA correlated neither with creatinine clearance nor with MAP. Our results suggest that hypertension may develop as a consequence of the long-lasting, higher GFR, which may accelerate the age-related process of sclerosis both in the small arterioles and the glomeruli.

[Serum levels of uric acid, lipids and glucose in essential hypertension]. / Nivo uricne kiseline, lipida i glikoze u serumu i esencijalna arterijska hipertenzija.

In 48 men, 42, 1 +/- 8.8 yrs old, with untreated mild essential hypertension, serum uric acid, total cholesterol triglycerides and glucose were examined at 8 a.m after 16 hour overnight fasting. All patients were overweight, with body mass index: 26.9 +/- 2.4 kg/m2, (normal value: 19-24.9); serum uric acid 293.1 +/- 89.3 mmol/l; cholesterol 6.3 +/- 1.4; triglycerides 2.0 +/- 1.3 and glucose 5.4 +/- 0.9 mmol/l. File out of 48 (10.4%) patients had hyperuricemia, nine (18.7%) had hypercholesterolemia, twenty (41.7%) had hypertriglyceridemia and 19 (39.6%) had hyperglycemia. Significant correlation between serum uric acid and triglycerides only (r = 0.35; p < 0.01), was found. A correlation exists between the diastolic blood pressure and cholesterol (r = 0.35; p < 0.01); as well as, between mean arterial blood pressure and cholesterol (r = 0.34; p < 0.02). Only three out of 48 (6.2%) patients with hypertension had all four biochemical parameters above normal levels. Our results suggest that interrelation of all these metabolic disorders are important in essential hypertension, and especially the association of high serum uric acid and triglyceride level.