Role of reactive hyperreninemia in blood pressure changes induced by sodium depletion in patients with refractory hypertension

H. Gavras, B. Waeber, G. R. Kershaw, C. S. Liang, Stephen C Textor, H. R. Brunner, C. P. Tifft, I. Gavras

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Sixteen patients with refractory hypertension were submitted to vigorous sodium depletion while cardiovascular homeostasis was monitored with measurements of hormonal and hemodynamic paramaters and repeat saralasin tests. This regimen resulted in a negative sodium balance by an average of 300 mEq. The loss of sodium closely correlated to the decrease of body weight (r = 0.70, p <0.005). Blood pressure (BP) decreased from 176/116 ± 8/3 to 155/109 ± 6/3 mm Hg. There was a significant correlation between percent increments in plasma renin activity (PRA) and the rise in plasma norepinephrine (r = 0.68, p <0.05) and a close negative correlation between percent increase in PRA and the ratio of fall in mean blood pressure (MAP) per unit of weight loss (r = -0.73, p <0.005). Thus, patients with the least percent increase in PRA demonstrated the greatest fall in BP per unit of weight loss, indicating that relative rather than absolute elevation of renin may be the factor limiting antihypertensive efficacy of sodium depletion. Sodium depletion induced increase in peripheral resistance and decrease in cardiac output, both mostly attributable to relative hyperreninemia. Indeed, the adverse hemodynamic changes were reversed by angiotensin inhibition, during which BP normalized. It is concluded that vigorous sodium depletion complemented by angiotensin blockade or suppression with sympatholytic agents improves management of otherwise refractory hypertension.

Original languageEnglish (US)
Pages (from-to)441-447
Number of pages7
JournalHypertension
Volume3
Issue number4
StatePublished - 1981
Externally publishedYes

Fingerprint

Sodium
Blood Pressure
Hypertension
Renin
Angiotensins
Weight Loss
Hemodynamics
Sympatholytics
Saralasin
Cardiac Output
Vascular Resistance
Antihypertensive Agents
Norepinephrine
Homeostasis
Body Weight

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Gavras, H., Waeber, B., Kershaw, G. R., Liang, C. S., Textor, S. C., Brunner, H. R., ... Gavras, I. (1981). Role of reactive hyperreninemia in blood pressure changes induced by sodium depletion in patients with refractory hypertension. Hypertension, 3(4), 441-447.

Role of reactive hyperreninemia in blood pressure changes induced by sodium depletion in patients with refractory hypertension. / Gavras, H.; Waeber, B.; Kershaw, G. R.; Liang, C. S.; Textor, Stephen C; Brunner, H. R.; Tifft, C. P.; Gavras, I.

In: Hypertension, Vol. 3, No. 4, 1981, p. 441-447.

Research output: Contribution to journalArticle

Gavras, H, Waeber, B, Kershaw, GR, Liang, CS, Textor, SC, Brunner, HR, Tifft, CP & Gavras, I 1981, 'Role of reactive hyperreninemia in blood pressure changes induced by sodium depletion in patients with refractory hypertension', Hypertension, vol. 3, no. 4, pp. 441-447.
Gavras, H. ; Waeber, B. ; Kershaw, G. R. ; Liang, C. S. ; Textor, Stephen C ; Brunner, H. R. ; Tifft, C. P. ; Gavras, I. / Role of reactive hyperreninemia in blood pressure changes induced by sodium depletion in patients with refractory hypertension. In: Hypertension. 1981 ; Vol. 3, No. 4. pp. 441-447.
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