[Comparison of treatment effects with an angiotensin converting enzyme inhibitor--lisinopril and a calcium blocker--nifedipine retard on urinary albumin excretion in patients with non-complicated essential hypertension]. / Porównanie wplywu leczenia inhibitorem enzymu konwertujacego--lizynoprylem i blokerem wapnia--nifedypina retard na wydalanie albumin z moczem u chorych z samoistnym niepowiklanym nadcisnieniem tetniczym.

The purpose of the study was to compare the effect of treatment with an angiotensin converting enzyme inhibitor (Lisinopril, MSD) or calcium blocker (Nifedipine retard, MSD) treatment during three months on blood pressure (measured with sphygmomanometric method and ambulatory blood pressure monitoring--ABPM) and urinary albumin excretion in essential hypertension class I acc. to WHO. Fifteen untreated patients aged 38 +/- 5 years with essential hypertension participated in the study and received diet with normal sodium content. Urinary albumin excretion was measured by RIA method in two 24 hour urine collections and mean value was calculated. ABPM was measured with Spacelabs monitor. After first examination 8 patients were randomly selected for the treatment with lisinopril and 7 patients to the treatment with nifedipine. The doses of both drugs were gradually adjusted to reach diastolic blood pressure below 90 mmHg. After 3 months of treatment urinary albumin excretion and blood pressure was found in both after treatment in patients treated with lisinopril but not in those receiving nifedipine. In patients treated with lisinopril a correlation between the decrease in systolic and diastolic blood pressure (measured by ABPM) and decrease of urinary albumin excretion was demonstrated. It was concluded that the normalization of blood pressure induced by lisinopril treatment in patients with uncomplicated essential hypertension and normoalbuminuria is accompanied with significant diminution of urinary albumin excretion which suggests preventive action of the drug in the development of microalbuminuria. Diminution of urinary albumin excretion caused by lisinopril is probably due to both the decrease of blood pressure and the specific renal action of the drug.

[Effect of different amounts of dietary sodium on plasma atrial natriuretic peptide (ANP)in essential salt sensitive hypertension]. / Wplyw róznej ilosci sodu w diecie na stezenie w osoczu przedsionkowego peptydu natriuretycznego (ANP) w pierwotnym nadcisnieniu tetniczym sodowrazliwym.

The aim of the study was an evaluation of the effect of different dietary sodium intake on: blood pressure, plasma concentration of atrial natriuretic peptide (ANP), cyclic guanosine monophosphate (cGMP), aldosterone (ALDO) and plasma renin activity (PRA) in patients with primary sodium sensitive arterial hypertension class I acc. to WHO criteria. Thirteen patients, non treated, with sodium sensitive arterial hypertension aged 30 +/- 8 years participated in the study. Blood samples were taken three times: in 5th day of normal sodium intake (100-120 mmol Na per 24 h); in 5th day of low sodium diet (10-20 mmol Na per 24 h); in 5th day of high sodium diet (200-220 mmol Na per 24 h). During 24 hours before each blood sampling the urine was collected and sodium and potassium excretions were evaluated. Concentrations of ANP, cGMP, ALDO in plasma and PRA were determined by radioimmunoassays and serum sodium and potassium concentration by flame photometry. Significant (p < 0.05) diminution of blood pressure, plasma ANP and cGMP concentrations and the increase of plasma ALDO and PRA after sodium restriction when compared to normal sodium diet were found. High sodium diet resulted in significant increase of blood pressure, plasma ANP and cGMP concentrations to the values comparable with these on normal sodium diet. On the contrary PRA and plasma ALDO concentration decreased (p < 0.001) below the values during normal sodium diet. Urinary sodium excretion corresponded to dietary sodium intake during all diets.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of intravenous sodium chloride load on levels of atrial natriuretic peptide (ANP) and 3'5' guanosine monophosphate (cGMP) in plasma of patients with uncomplicated sodium-sensitive arterial hypertension maintained on different dietary sodium intake]. / Wplyw dozylnego obciazenia ladunkiem sodu na stezenie przedsionkowego peptydu natriuretycznego (ANP) i 3'5' guanozynomonofosforanu (cGMP) w osoczu chorych z niepowiklanym samoistnym nadcisnieniem tetniczym sodowrazliwym zywionych dieta o róznej zawartosci sodu.

The aim of this work was an evaluation of the effect of the acute hypervolemia induced by 90 min intravenous infusion of 1500 ml 0.9% NaCl (16.7 ml/min) on blood pressure, plasma concentration of the atrial natriuretic peptide (ANP), cyclic guanosine monophosphate (cGMP), aldosterone (ALDO), plasma renin activity (PRA) in patients with essential hypertension on the normal, low and high sodium intake. Twelve patients with noncomplicated essential sodium-sensitive arterial hypertension participated in the study. Sodium chloride infusions were performed three times: first--on the fifth day of normal daily sodium u intake (110-120 mmol/day), second--on the fifth day of low sodium intake (10-20 mmol/day), third--on the fifth day of high sodium intake (200-220 mmol/day). Acute intravenous sodium chloride load induced a significant increase of the mean arterial pressure (MBP) only when the patients were on the high sodium diet. This increase of the MBP was associated with a significantly lower increment of plasma ANP, cGMP, lower decrement of ALDO and PRA when compared to normal- or low- sodium intake. The results suggest an impairment of the adaptive homeostatic mechanisms induced by an acute intravenous sodium load in patients with noncomplicated salt-sensitive essential hypertension ingesting high-sodium diet.

Exaggerated natriuresis induced by sodium chloride infusion in essential hypertension is accompanied by an exaggerated urinary 3' 5' guanosine monophosphate excretion.

The effects of an intravenous infusion of physiological saline on plasma atrial natriuretic peptide (ANP), guanosine 3' 5' monophosphate (cGMP) concentrations, and on urinary cGMP and sodium excretion were studied in 13 patients with essential hypertension, class I according to WHO criteria, and in 10 healthy subjects. It was found that the groups did not differ as to basal and infusion-induced plasma ANP and cGMP and basal urinary cGMP and sodium excretion, but the sodium chloride infusion resulted in a significantly greater urinary cGMP and sodium excretion and creatinine clearance in hypertensive than in control subjects. The results of this study demonstrate that patients with essential hypertension respond to an intravenous sodium chloride load not only with exaggerated natriuresis, but also with augmented urinary cGMP excretion. The latter finding may in part be due to a greater glomerular filtration of cGMP, but increased renal contribution cannot be excluded. Apart from the possible stronger intrarenal effect of ANP on cGMP production in patients with hypertension, independent direct effect of volume expansion on cGMP excretion and modified activity of other cGMP generating systems may all be responsible for the higher urinary cGMP excretion in essential hypertension.

Iodized salt consumption, urinary iodine concentration and prevalence of goiter in children from four districts of north-western Poland (Szczecin coordinating center).

The study was aimed at evaluation of iodized salt consumption, urinary iodine concentration and incidence of goiter in children from four districts of north-western Poland: Szczecin, Koszalin, Slupsk and Gorzów Wlkp. The study was a part of the national programme: "Investigations of iodine deficite and iodine prophylaxis in Poland". The investigations were performed in ten schools randomly selected by Coordinating Centre in Kraków. Altogether 1793 children attending these schools (838 boys and 955 girls) of age between 6 ad 13 years, living in the cities and villages of coastal and lowland region were studied. The examination included interview in the form of a standard questionnaire, physical examination of the thyroid according to the WHO criteria, ultrasonographic evaluation of thyroid volume and determination of iodine concentration in single urine specimen. It appeared that only 11.2% of children used to consume iodized salt. Mean iodine concentration in urine was 76.2 micrograms/l both in children consuming and not consuming iodized salt, indicating dietary iodine deficiency. The incidence of goiter in country population of children (12.9%), indicated that the region of north-western Poland should be considered as an area of mild goiter endemy. These results suggest a need for iodine supplementation of edible salt in this region of Poland.