Influence of left ventricular hypertrophy on heart rate variability in hypertensive patients.

Long-term heart rate variability (HRV) data were obtained from 38 patients with arterial hypertension and 20 healthy persons. New method of HRV analysis based on calculation and estimation of variations of short rhythmogram intervals (SRV) was applied. This method showed that HRV level depends on number of factors. The most significant of them are patient's age, arterial hypertension form and duration, and left ventricular hypertrophy degree. Patients with these risk factors may be highly predisposed to rate variability decrease. (Tab. 8, Ref. 8.)

[Comparative evaluation of the efficacy of methods of cryo- and trypsin activation of inactive renin in vitro]. / Sravnitel'naia otsenka éffektivnosti metodov krio- i tripsinovoi aktivatsii neaktivnogo renina in vitro.

The total renin activity (TRP) and inactive renin levels (IR) in the blood plasma were examined with the help of cryo- and trypsin activation in 9 normal subjects, in 40 patients with essential hypertension and in 18 patients with primary aldosteronism (PA). The cryoactivation method was shown to detect 40-80% of IR determined by the method of trypsin activation. Both methods revealed analogous ratios of the two renin forms in its total production in the presence of essential hypertension (in different "renin" subgroups) and arterial hypertension secondary to PA and may be used as the methods of choice when examining essential hypertension patients with the normal and subnormal plasma renin activity. The method of trypsin activation is more preferable for a more accurate quantification of small amounts of IR found in essential hypertension patients with a high plasma renin activity. With a high level of the TRP (over 8 ng/ml/h) activation should be performed in diluted plasma.

[Skin vascular reactivity to noradrenaline in healthy subjects and hypertensives based on data from a method continuously recording the intensity of reflected light]. / Reaktivnost' kozhnykh sosudov k noradrenalinu u zdorovykh lits i bol'nykh gipertonicheskoi bolezn'iu po dannym metoda nepreryvnoi registratsii intensivnosti otrazhennogo sveta.

A method of investigating vascular response to noradrenaline is described, based on a continuous recording of changes in the intensity of reflected monochromatic light following rationed intracutaneous administration of vasoactive substances. The results of vascular response studies in 16 normal subjects and 92 patients with labile and stable essential lypertension are discussed. The amplitude of vasospastic response was shown to increase in proportion to the dose administered in both groups. Patients with stable essential hypertension demonstrated higher amplitude and longer duration of vasospastic response as well as a lower noradrenaline-sensitivity threshold.

[Change in plasma renin activity in patients with hypertension and healthy persons after furosemide intake]. / Izmenenie aktivnosti renina v plazme krovi u bol'nykh gipertonicheskoi bolezn'iu i zdorovykh liudei posle priema furosemida.

Blood plasma renin activity was studied by the radioimmune method in clino- and orthostatism in 36 males with hypertensive disease and in 15 healthy males before and after 3-day medication with furosemide in a daily dose of 120 mg under in-patient conditions. Renin activity proved to be higher in double stimulation (in orthostatism after furosemide intake) than in orthostatism before the intake of the drug. Diversity was revealed between patients with different stages of hypertensive disease. Stage IB of the disease was characterized by increased renin activity in orthostatism and marked reaction to stimulation with furosemide. In stage IIB, on the contrary, renin activity was low and the reaction to stimulation with furosemide weak. Hypotensive effect after intake of furosemide was observed in patients with IIB stage of hypertensive disease.

[Results of radioimmunologic determination of renin activity and the concentration of angiotensin II in the plasma of hypertensive patients]. / Rezul'taty radioimmunologicheskogo opredeleniia aktivnosti renina i kontsentratsii angiotenzin II v plazme krovi bol'nykh gipertonicheskoi bolezn'iu

Studies of plasma renin activity performed by way of radioimmunoassay in 44 patients with essential hypertension permitted to subdivide the patients with Stage 2 disease into 2 groups: Group 1 with normal or elevated plasma renin activity, and Group 2 -- with sub-normal activity. A statistically significant reverse relationship was found between the age of the hypertensive patients and their plasma renin activity; this parameter tends to decrease along with the increasing duration of the disease. With paralled determinations of renin activity by way of radioimmunoassay and biological method in 20 patients a positive correlation was established; the figures obtained by radioimmunoassay were twice as high as those obtained by the biological technique. A radioimmunological determination of the concentration of angiotensin II in 14 patients with essential hypertension and in 4 normals permitted to reveal its elevation over the level of the normals in 10 of the patients. Positive correlation was established between the renin activity and the angiotensin II concentration.

[Pathogenesis of arterial hypertension with a low renin activity in the blood plasma]. / O patogeneze arterial'noi gipertonii s nizkoi aktivnost'iu renina v plazme krovi.

The possible pathogenetic mechanisms underlying arterial hypertension with low activity of renin in blood plasma are discussed. The peculiarities of some of its forms marked by normal or increased blood plasma aldosterone content are considered. Criteria for distinguishing a subgroup of patients with hypertensive disease marked by low blood plasma renin activity and for the differentiation of patients with primary and secondary hyperaldosteronism are substantiated.

[Tubulointerstitial nephritis in Conn's syndrome]. / K voprosu o tubulointerstitsial'nom nefrite pri sindrome Konna.

The evaluation of 79 renal biopsies from patients with primary aldosteronism established pathology in one-fourth of the examinees. There were specific dystrophic and atrophic lesions of the tubular apparatus, focal interstitial sclerosis and disseminated round-cell infiltrates. Immunomorphological evaluation showed these to have macrophages and T lymphocytes as cellular components. The process manifested clinically by steady hypofunction of osmotic diuresis in the absence of bacterial inflammation and calycine-pelvic destruction. No relation of this condition with inflammation in onset and signs of immune origin of such give good grounds to refer the pathology to tubulointerstitial nephritides of immune genesis.

[Correlation of the total activity of blood plasma renin with levels of active and inactive renin, angiotensinogen and angiotensin II under different functional loads in patients with hypertension]. / Sootnoshenie obshchei aktivnosti renina plazmy krovi, soderzhaniia aktivnogo i neaktivnogo renina, angiotenzinogena i angiotenzina II pri razlichnykh funktsional'nykh nagruzkakh u bol'nykh gipertonicheskoi bolezn'iu.

Components of the renin-angiotensin system (plasma renin activity, total and inactive renin, angiotensinogen and angiotensin II) were examined in 90 patients with labile and stable essential hypertension before and after functional and pharmacologic tests. New data have been obtained on intrasystemic regulatory mechanisms of the pressor renin-angiotensin systems. Different patterns of plasma active and inactive renin variations in response to salt loading are demonstrated in patients with different "renin" variants of essential hypertension. Angiotensin II is shown to have a stimulating effect on angiotensinogen synthesis.

[Effect of salt on the functional state of the renin-angiotensin-aldosterone system in healthy persons and hypertensives]. / Vliianie soli na funktsional'noe sostoianie renin-angiotenzin-al'dosteronovoi sistemy u zdorovykh i bol'nykh gipertonicheskoi bolezn'iu.

A total of 16 normal subjects and 30 patients with IB (labile hypertension) and IIB (stable hypertension) stages of essential hypertension during excessive salt intake as well as 13 normal persons and 43 patients at the labile and stable stages of essential hypertension on usual salt diet were examined. Renin activity, plasma aldosterone and cortisol levels were studied using radioimmunoassay in the basal conditions and 1 and 5 hours later after intravenous administration of 5% saline solution (3,6-3,8 mu mole of sodium (1 kg body mass). It was demonstrated that the prolonged excessive intake of sodium hydrochloride resulted in the alteration of the functional state of the renin-angiotensin-aldosterone system even in the normal persons. The above alterations are characterized by the loss of the adequate response of the renin-angiotensin system and the adrenal cortex to the increased sodium concentration, and extracellular fluid volume in the body, as well as by the separation of the functions of these two humoral systems.

[Mechanisms of the hypotensive action of captopril in essential hypertension]. / Mekhanizmy gipotenzivnogo deistviia kaptoprila pri gipertonicheskoi bolezni.

Captopril effects were studied in 27 patients with second-stage essential hypertension following administration of a single 25 mg oral dose of the drug. Blood pressure (BP), blood angiotensin-1-converting enzyme (ACE) activity, active (APR) and inactive (IPR) plasma renin levels were measured every 30 minutes for 3 hours. Before and near the end of the acute test, urinary kallikrein and catecholamine excretions were measured, and systemic and regional hemodynamic changes assessed. BP decreased in 21 patients: 11 of those had low basal APR (group 1), and 10 had normal or moderately elevated APR (group 2). The greatest hypotensive effect was observed within 1.5 hours after the administration, coinciding with the most marked ACE inhibition. There was no significant intergroup difference with respect to the extent of the hypotensive effect. No correlation was found between the hypotensive effect and the degree of ACE inhibition. All patients showed significantly decreased arteriolar tone, increased venous distensibility, decreased total peripheral resistance, and expanded end diastolic volume, while their cardiac output and heart rate remained unaffected. Hypertensive patients with low APR gave no evidence of renin-angiotensin inhibition or kallikrein-kinin activation that might have accounted for the hemodynamic effect of captopril.

[Reactivity of the cardiovascular system and of the pressor neurohumoral systems in hypertension patients]. / Reaktivnost' serdechno-sosudistoi sistemy i nekotorykh pressornykh neirogumoral'nykh sistem u bol'nykh gipertonicheskoi bolezn'iu.

Correlations between sympathoadrenal, renin-angiotensin and cardiovascular (BP and heart rate) response to psychoemotional and physical stress and antebrachial skin vascular response to noradrenaline were examined in patients with essential hypertension. Four groups of patients were identified on the basis of the magnitude of variation in the examined parameters. The progress of the disease over the past two years was assessed in all patients. The prognosis was particularly unfavorable in the "hyperreactive" group which showed a set of distinctive features: increased vascular response to noradrenaline, a greater BP rise in response to stress, greater sympathoadrenal activation, increased neuroticism, as well as significantly older age of the patients and greater severity and duration of the disease. No intergroup differences in plasma renin activity could be demonstrated. Possible use of vascular response to noradrenaline, and BP and plasma catecholamine variation in response to psychoemotional stress as criteria for the assessment of the severity and outcome of essential hypertension is discussed.

[Functional state of the adrenals in various forms of arterial hypertension]. / Otsenka funktsional'nogo sostoianiia nadpochechnikov pri nekotorykh formakh arterial'noi gipertenzii.

The study of structural changes and changes of the aldosterone content (AC) in the surgically removed adrenals of patients with different clinical variants of combination of the arterial hypertension (AH), low--renin hyperaldosteronism and space--occupying lesions in the adrenals found by CT was carried out. In 15 of 20 patients after adrenalectomy the diagnosis of the primary aldosteronism (PA) was established, in 4 cases diagnosis of the hypertension, 2B degree, and in one case the diagnosis of Cushing disease. The functional state was evaluated according to AC in the adenomas and macronodes and in the adjacent cortex as well as by nuclei size of cells producing aldosterone. The aldosterone hyperproduction was shown to be associated with local adenoma in some cases and with hyperactive cortex in the others this being reflected in the course of AH and in the adrenalectomy hypotensive effect.

[Evaluation of the hypotensive effect and indications for the operation of nephropexy in patients with arterial hypertension combined with nephroptosis]. / Otsenka gipotenzivnogo éffekta i pokazaniia k operatsii nefropeksii u bol'nykh arterial'noi gipertoniei v sochetanii s nefroptozom

The results of the examination and nephropexy operation in 11 patients with arterial hypertension and nephroptosis are presented; a hypotensive effect was achieved in 5 of the operated patients; the follow-up period was up to 3 years. The recordings included the elevation of the arterial pressure in orthostasis, the changes in the urine sediment, the activity of plasma renin at rest and after 1-hour's orthostasis; excretory urography and the Seldinger abdominal aortography in a lying and upright position of the patient were conducted, as well as intraoperative biopsy of the renal tissue. Patients with a hypotensive effect exhibited a regular elevation of the arterial pressure in orthostasis, an increased plasma renin activity, congestive features in the descended kidney. The above symptoms permit to distinguish groups of patients with a hypotensive effect achieved after nephropexy, and those without effect. On the basis of the obtained results it was concluded that in some cases nephroptosis may be the cause of symptomatic arterial hypertension. In such cases it seems rational to recommend the nephropexy operation taking into account, when determining the indications for surgery, the degree of the orthostatic elevation of the arterial pressure and of the renin activity, and the symptoms of disorders in the renal evacuation function.

[Use of captopril (capoten) in arterial hypertension]. / Primenenie kaptoprila (Kapotena) pri arterial'noi gipertonii.

Capoten (captopril) treatment was conducted in 39 patients with essential hypertension of stage IIA-IIB and in 4 patients with idiopathic hyperplasia of the adrenals. In 35 patients the hypotensive effect was evaluated following a single administration of captopril in a dose of 12.5, 25 and 50 mg. Twelve patients were treated with this drug alone while in 23 patients it was combined with saluretics. Captopril monotherapy elicited a good and moderate hypotensive effect in 70% of patients with a high and stable hypertension. Both mono- and combined therapy was associated with a decrease in adrenaline and noradrenaline excretion and an increase in uterine kallikrein excretion. The examination of the regional circulation revealed a significant reduction in the resistance and tonus of the arterioles and an enhancement of the blood flow in the forearm as well as an increase in venous tensility. When captopril was combined with diuretics these changes were less marked.

[Concentration of adrenocorticotrophic hormone and aldosterone secretion in essential hypertension and hyperaldosteronism]. / Soderzhanie adrenokortikotropnogo gormona i sekretsiia al'dosterona pri gipertonicheskoi bolezni i giperal'dosteronizme.

The authors studied the effect of adrenocorticotropic hormone (ACTH), potassium and plasma renin activity on blood aldosterone in normal subjects as well as in patients with essential hypertension (of a labile and stable course) and hyperaldosteronism (primary and idiopathic). It was demonstrated that in normal subjects and patients with labile essential hypertension, the secretion of aldosterone was simultaneously stimulated by the renin-angiotensin system (RAS) and the hypothalamus-adenopituitary. The RAS dominated in normal conditions whereas in labile hypertension the hypothalamus-adenopituitary system was predominant. In stable hypertension, the RAS and hypothalamus-pituitary influenced aldosterone secretion in an equal degree. Hyperaldosteronism was associated with the most pronounced deviations in the relationship between stimulants and aldosterone. In addition to decreased plasma levels of renin activity and potassium, the corticotropic activity of the hypothalamus-adenopituitary was increased during the first 10 years of the disease, while later on the function of this system became inhibited. The highest ACTH levels were recorded in idiopathic hyperaldosteronism.

[Various humoral pressor and depressor systems in hypertension]. / Nekotorye gumoral'nye pressornye i depressornye sistemy pri gipertonicheskoi bolezni.

Study of the hormone content and enzyme activity in patients with hypertensive disease at rest and in various types of stimulation revealed predominance of pressor humoral systems over depressor ones. With the development of the disease, the reaction of these humoral systems to stimulation diminishes. Decrease of the renin-angiotensin-aldosterone system compensatory reaction and the prostaglandin F level in patients with stable, high arterial pressur in response to furosemide administration may be among the causes of the hypotensive and natriuretic effect of this preparation. Activization of the humoral depressor systems in the initial stage of the disease is conducive to the preservation of the water-electrolyte hemostasis in the organism and maintains the labile level of arterial pressure despite the increased activity of the natrium-retaining hormones. Exhaustion of the humoral depressor systems may be one of the causes of arterial pressure stabilization.

[Low renin variant of hypertension: functional relations of the renin-aldosterone pressor system]. / Nizkoreninovaia forma gipertonicheskoi bolezni: osobennosti funktsional'nykh sootnoshenii pressornoi sistemy renin-al'dosteron.

Renin-aldosterone function was studied in 23 patients with low-renin essential hypertension (LREH) under resting and stimulated conditions. Patients were selected on the basis of differential diagnostic tests of renin-angiotensin stimulation and inhibition as well as roentgeno-radiologic findings in order to rule out adrenal lesions. The results were compared with those of patients with primary aldosteronism and with essential hypertension where renin activity can be stimulated under similar sodium balance conditions. Intravenous or prolonged furosemide administration was shown to be the test of choice for the diagnosis of renin suppression. The renin-aldosterone system of LREH patients featured subnormal renin activity and normal aldosterone levels in baseline conditions, and the lack of renin stimulation together with limited aldosterone stimulation following functional tests. The analysis of changes in diuresis, natriuresis and the pattern of Na/K coefficient points to a great diuretic and natriuretic effect of furosemide in patients with LREH.

[Significance of single-dose captopril test in the differential diagnosis of primary aldosteronism]. / Znachenie testa s odnorazovym priemom kaptoprila v differentsial'noi diagnostike pervichnogo al'dosteronizma.

The captopril test was used to make a differential diagnosis of various types of primary aldosteronism. After captopril, there was no change in the activity of the renin-angiotensin-aldosterone system only in the group of patients with aldosterone-producing adenomas in a histological variant of "adenoma and atrophy". The findings suggest that aldosterone secretion regulation is autonomic in the adenoma unassociated with the function of the renin-angiotensin-aldosterone system only in the case of isolated adenoma with a histological variant of adenoma and atrophy. In patients with aldosterone-producing adenomas in the presence of the variant "adenoma and hyperplasia", aldosterone secretion retains sensitivity to the renin-angiotensin-aldosterone system as in patients with idiopathic hyperplasia and hypertensive disease, which indicates that it is possible to differentiate isolated "adenoma and atrophy" from hypertensive disease and idiopathic hyperplasia, despite its combination with tumor by using the captopril test.

[Endogenic activation of prorenin in hypertension]. / Ob endogennoi aktivatsii prorenina pri gipertonicheskoi bolezni.

Two forms of renin (active-APR and inactive-IPR) and its total production were studied in relation to the daily excretion of kallikrein in patients with essential hypertension of the labile and the stable stage at rest and following the stimulation by an hour's walk and the intravenous infusion of prostaglandin E (PGE). The results showed inverse correlations of APR and IPR in the total production of renin in hypertensive patients in different "renin" subgroups, and an inverse correlation between the level of IPR and the 24-hour excretion of kallikrein in the basal conditions and following an hour's walk. PGE infusion elevated APR and decreased IPR levels, leaving the total production of renin unchanged. The level of kidney kallikrein was inversely correlated with IPR and directly correlated with APR. The findings suggested the involvement of kidney kallikrein in the endogenic activation of prorenin.

[Plasma mineralocorticoids--aldosterone and desoxycorticosterone-- in patients with"low-renin"arterial hypertension]. / Mineralokortikoidy plazmy--al'dosteron i dezoksikortikosteron-- u bol'nykh s "nuzkoreninovoi" arterial'noi gipertoniei.

The plasma aldosterone (A) and desoxycorticosterone (DOCS) levels were measured in 10 patients with primary aldosteronism and in 2 subgroups with low-renin hypertensive disease (LRHD): (1) those with normal adrenal glands++ (n - 11) and (2) those with structural changes in the cortex (n - 11). The patients from Subgroup 1 showed the lowest basal A and DOCS levels (107.29 +/- 12.90 and 0.080 +/- 0.013 ng/ml, respectively) and low concentrations of the two hormones after stimulation of 4-hour walk (211.57 +/- 30.47 and 0.095 +/- 0.024 ng/mg, respectively). In the patients from Subgroup 2, the basal and 4-hour post-walk++ A and DOCS contents were increased in the cortex (basal 201.50 +/- 41.59 and 0.177 +/- 0.36 ng/mg and poststimulation 331.33 +/- 30.47 and 0.302 +/- 0.061 ng/ml, respectively). Some patients with primary aldosteronism displayed the same DOCS response to stimulation as did those with LRHD in the presence of structural cortical changes. Histological examination of operative biopsy specimens indicated that higher DOCS levels were associated with diffuse nodal hyperplasia of the zona fasciculata in the cortex. The results suggest that there may be a LRHD variant running with excessive DOCS secretion and related to pathogenetically related to hyperplasia of predominantly the zone fasciculata in the adrenal cortex.