Blood Pressure Response to Norepinephrine Infusion in Relationship to Plasma Catecholamines and Renin Activity in Man NICOLAS

B

both

ECAUSE

and

norepinephrine

sympathetic

vasoconstriction and has been speculation epinephrine hypertensive mine

metabolites

or

reports

failed

plasma

catecholamines

been

when

studied.7’8 It has

been

reported

low,3

to show

tension

uniformly

recent elevated

in essential

shown

for

many to

were

years

that

various

stim-

uli9’4 sion.

is increased in essential hypertenBoth the intravenous and intraar-

terial were

administrations associated with

cular

reactivity

sion,

but

not

However, doses

in are

weight,

the

Dr.

Medicine, University Cal. This Meetings

Pharmacology,

although kilogram

concentrations was

not

California, School

of

Vlaehakis Division

to

ex-

Cal.,

New

Professor Pharmacology,

and

York, of

effect blood

activity

There

clinical

data

are

less that,

than 140/90 mm Hg without treatment,

used.15 eases,

laboratory

and

blood

multichannel

chemistries,

and test.

were

graded scale.

ventricular

Patients

with heart Journal

urine

Changes For

scoring renal

evalua-

Clinical

the

system

was

or hepatic

dis-

disease, of

in

according

hypertrophy

Estes

ischemic The

x-ray,

complete

metabolite fundi

left

chest

urinalysis,

Keith-Wagner of

hyper-

procedures

pyelogram, blood

ocular

tion

were

many above the last 12

Sustained

and

routine

Rombilt

when

readings

present when blood pressure was greater than 140/90 mm testing consisted of physical

sequence

the

in Table

present

and in

electrocardiogram,

count,

to

pressure

observation.

examination

the

examined.

presented

or more

tension was consistently Hg. Routine

plasma

15 patients with hypertension. was

blood

into

and

was

were primary

one

including

its and

norepinephrine

pressure

hypertension

of

in

divided

of

(PRA)

Group I. uncomplicated

months

and

subjects

subjects,

upon

Their

hypertensive

Methods

the

I. Labile

Cal.

catecholamines

twenty-five groups,

renin

Los Angeles,

activity.

and

In

in

plasma

catecholamine

Clinical California, Los Angeles, work was presented in the National of the American College of Clinical Washington, D.C., April 1977.

of Southern

Material

automated

University

Los Angeles, Medicine,

renin

rapid

measured. to norepi-

Medicine,

is Associate of

admin-

designed

responsiveness of

drug of body

of

were

Departments

vas-

hyperten-

hypertension.’#{176}

per

study

vascular

of Southern Mount Sinai

654

renal studies,

calculated

present

amine

N. Y.

essential

catecholamines

The

From

with these

plasma

istered

of norepinephrine an increase in

with

plasma

infusion

hyper-

groups

reactivity

to

two

F.C.P.

normotensive

relation

as

while

age-matched

neurovascular

there of nor-

M.D..

infusion

age-matched

hypertension. In urinary catechola-

have

elevated,

nephrine

produce

hypertension, about the role

in essential patients

normal,

infusion1

stimulation2

D. YLACHAKIS.

congestive Pharmacology

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heart

failure,

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bradycardia,

or

were

excluded

ous

medication

three

from prior

of

II.

53

1.7

of

procedures

gram,

complete

alysis,

and

blood The

written

in

was

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and

on

the

A

5%

every to

an

in the

was

per

to

for

of

at a rate

infusion turned 656

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a period (baseline),

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or

of

period and before off, blood was again

Houston, weight

In and

was for

Peuler’T

plasma norepiare converted catechol-O-methyl-

5-adenosylmethionine3H-normetanephrine

and

assay

The

is less

than

sensi-

1 pg

nor-

and epinephrine, and the test 50 jl or less of plasma. The dayvariability

cent

the

norin the

Johnson18

respectively.

the

cent The

and and

enzyme to

to-day per

Passon

Peuler

and

for

assay

this method epinephrine

purified

of

com-

angiotensinase method

by by

transferase

of

for for

the

assay

norepinephrine

average

blood of

pressures

seven baseline

and

phrine

infusion

periods.

The

urement

was

analysis

Student’s

disregarded.

i-test,

group.

also

determined. The

the for

Correlation

Journal

For

i-test

between

paired

represent

measurements

during

same

±1.2 ±3.8

epinephrine.

reported

comparisons

is and

tained

the

15-minute

the pump collected

by the

ac-

during

plasma

epinephrine

developed modified

was used. nephrine

renin

enzyme.16 and

plasma

determined

Plasma

radioenzymatic

epinephrine and

of

radioimmunoassay

generated of

converting

per

and norepinevia an infu-

the

I

estimation and potassium.

were

by

inhibition

(within

was obtained starting the

for

Mass.).

angiotensin

epinephrine requires

she

and then

(Instrumentation

assessed

tivity

of 15 blood

body

was

until plasma

centrifuge

collection subjects,

potassium

Lexington,

auto-

was

ice

the

20#{176}Cand

-

testing, sodium

and

was reobtained

in

and

photometry

3H-metanephrine,

catecholamines

of 0.1 pg/kg

of

flame

of

urine the

the

3H-methyl

conversahe

of

open.

subject

avoid

plasma

end

norsam-

an

Instruments. the

left

solution

by

testing unless to report.

(Texas

minute.

Sodium

A new

(Arteriosonde Inc., Nutley, The

and

the

for blood

recorded

2 minutes. relax

withdrawn

Texas),

in

kept

at

was

period, strip The

a cold

freezer

before excretion

and

of

in

the

A 24-hour from each

the

asked to cathe-

water

device Roche,

completion of relaxation

pump

in

the

rate

each

thawed and promptly analyzed two weeks of its collection).

plete

diet.

catheters

and PRA determination, phrine infusion was started sion

separated

kept

the

3 hours

one

were testing,

was

obtained

unrestricted

and

keep

during the any complaint

After minutes was

after

dextrose

pressure

advised tion had

of

was

subject was two indwelling

matically inflated 1216, Hoffmann-La N.J.)

estimation

right

to

were

during

Heart

of

of

end

by

each

studies

vein, were inserted infusion and for

used

Blood

from

blood

the and

in

antecubital epinephrine pling.

of

PRA.

end

specimens

the

day the

informed,

laboratory

position,

Subsequently, lie on a bed,

was

nature and

For

sitting

one

urinblood

obtained

profile,

ambulation,

ters,

routine

infusion in

renin

the

count,

experimental

hours.

plasma

labo-

the

in some subjects an ECG corded during both periods.

tivity

out

morning

and electrocardio-

explained,

consent

con-

multichannel

subject. Norepinephrine

ten the

testing

examination

was

least

were seven a mean age

including

and at

blood

There with

automated

testing

previat

Routine

physical

chemistries.

All

eatecholamines measured

group included age matched with

years.

ratory

carried

study.

withdrawn

subjects. three female

±

sinus

tachycardia

to testing.

This

sisted

the

the

volunteers

hypertensive male and

of

was

weeks

Group healthy

abnormalities,

history

obnorepine-

first

statistical

was two

changes

used groups within

coefficients

of

Clinical

meas-

Pharmacology

for and the were

BLOOD

PRESSURE

RESPONSE

TO

NOREPINEPHRINE

Results Hemodynamsc

Changes

to Plasma In

the

phrine

increased to

2006

fusion; and norepinephrine pg/mi

in

at

the

the

of

two

values

in

Hg,

with

Hg,

and

the

creased

an

pressure

of

15 ± group

increased

by

A

blood pres12 and 69 ±

5 mm

pressure

in-

29

mm

1.6

mm systolic

Hg.

In blood

to

mm

Hg,

10

‘4...

I

70 4

60

Hg,

32

with

DIASTOLIC

BLOOD

PRESSURE

mean

21.4

the

oE C

blood

#{149}

.

#{246}:#{246}

Hg,

mean

from

the

8.3

or

there

was

NORMO-

Fig. 1. Mean diastolic blood and hypertensive ence between

HYPERTENSIVE

7.3

the

increases

in

both

0.6

beats/min

change

was

±

1979

(A)

±

=

0.42,

1.1 beats/ and

by

normotensive. in both

groups

both), but the difference was not significant. There

correlation and

the

during a posi-

between

blood

pressure

heart change

rate in both

groups. Changes

Plasma

HYPERTENSIVE

In and

in normotensive (.) subjects. The differthe two groups was significant at P value less than 0.025 for the change in systolic and 0.01 for diastolic blood pressure. pressures

no

(r

group in

was

plasma

age

significant

for groups

(.0

Blood pressure response to norepinephrine infusion in relationship to plasma catecholamines and renin activity in man.

Blood Pressure Response to Norepinephrine Infusion in Relationship to Plasma Catecholamines and Renin Activity in Man NICOLAS B both ECAUSE and n...
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