Effect of enalapril (Reniteс) on the renin-angiotensin-aldosterone and sympathoadrenal system in hypertensive patients
https://doi.org/10.18705/1607-419X-2010-16-1-66-73
Abstract
Objective. To study the infl uence of enalapril 20 mg/day on the sympathoadrenal (SAS) and renin-angiotensinaldosterone
systems (RAAS). Design and methods. 149 subjects (102 patients with essential arterial hypertension (EAH)
and 47 patients with primary hyperaldosteronism, PHA) were included. Mean systolic blood pressure (BP) (M m) was
194,6 7,4 mmHg, diastolic BP - 116, 2 5,4 mmHg. Plasma renin activity (PRA) and plasma aldosterone concentration
(PAC) were estimated by radio-immune method in active patients. PRA was rated as normal if ranged 1,0-3,0 ng/ml/h,
PAC - 0,18-0,83 nmol/l (5-23 ng/dl or 50-230 pg/ml). Normal PAC/PRA ratio was 5-23. The daily urine excretion of
adrenaline (normal - 18-33 mmol/l) and noradrenaline (normal - 150-256 mmol/l) were determined by fl uorometric
method. Conclusions. 1) Effects of angiotensin-converting enzyme (ACE) inhibitors on the synthesis of aldosterone and
catecholamines in EAH patients are associated with the changes of circulating angiotensin II concentration, and in PHA
patients - with the decrease of tissue angiotensin II concentration in cortical layers of the adrenal gland and central nervous
system. 2) Reactive increase PRA in EAH patients treated with enalapril is rather related to the blockade of renal tissue
angiotensin-converting enzyme than to the circulating angiotensin II. 3) PHA patients are characterized by the phenomenon
of up regulation of aldosterone receptors and of tissue renin-angiotensin system that is defi ned by optimum reduction of
PAC, the lack of normalization of PRA and blood pressure in response to the application of enalapril 20 mg/day.
systems (RAAS). Design and methods. 149 subjects (102 patients with essential arterial hypertension (EAH)
and 47 patients with primary hyperaldosteronism, PHA) were included. Mean systolic blood pressure (BP) (M m) was
194,6 7,4 mmHg, diastolic BP - 116, 2 5,4 mmHg. Plasma renin activity (PRA) and plasma aldosterone concentration
(PAC) were estimated by radio-immune method in active patients. PRA was rated as normal if ranged 1,0-3,0 ng/ml/h,
PAC - 0,18-0,83 nmol/l (5-23 ng/dl or 50-230 pg/ml). Normal PAC/PRA ratio was 5-23. The daily urine excretion of
adrenaline (normal - 18-33 mmol/l) and noradrenaline (normal - 150-256 mmol/l) were determined by fl uorometric
method. Conclusions. 1) Effects of angiotensin-converting enzyme (ACE) inhibitors on the synthesis of aldosterone and
catecholamines in EAH patients are associated with the changes of circulating angiotensin II concentration, and in PHA
patients - with the decrease of tissue angiotensin II concentration in cortical layers of the adrenal gland and central nervous
system. 2) Reactive increase PRA in EAH patients treated with enalapril is rather related to the blockade of renal tissue
angiotensin-converting enzyme than to the circulating angiotensin II. 3) PHA patients are characterized by the phenomenon
of up regulation of aldosterone receptors and of tissue renin-angiotensin system that is defi ned by optimum reduction of
PAC, the lack of normalization of PRA and blood pressure in response to the application of enalapril 20 mg/day.
About the Authors
Sh. V. Akhadov
Clinical Hospital № 154
Clinical Hospital № 81
Russian Federation
Russian Federation
G. R. Ruzbanova
Clinical Hospital № 81
Russian Federation
Russian Federation
A. Sh. Akhadova
N.I. Pirogov Russia State Medical University
Russian Federation
Russian Federation
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Review
For citations:
Akhadov Sh.V., Ruzbanova G.R., Akhadova A.Sh. Effect of enalapril (Reniteс) on the renin-angiotensin-aldosterone and sympathoadrenal system in hypertensive patients. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2010;16(1):66-73. (In Russ.) https://doi.org/10.18705/1607-419X-2010-16-1-66-73
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