[Features of dopaminergic system function in menopausal females with arterial hypertension]. / Osobennosti funktsional'nogo sostoianiia dofaminergicheskoi sistemy u zhenshchin s arterial'noi gipertoniei klimaktericheskogo perioda.

AIM: Assessment of dopaminergic activity by changes in urine excretion of dopamine, arterial hypertension, blood prolactine, 24-h diuresis and natriuresis in response to a single (2.5 mg) and 7-day (daily dose 5 mg) administration of parlodel in patients with essential hypertension (EH) in menopausal and reproductive age having different serum levels of estrogens. MATERIALS AND METHODS: The indices of 52 hypertensive menopausal women and of 18 women at reproductive age of whom 8 had hypothalamic syndrome were followed up. RESULTS: A single dose parlodel (bromocriptine) in the dose 2.5 mg 2 hours after its administration caused a significant fall in arterial pressure, rise in 24-h diuresis in hypertensive menopausal women (p < 0.01). Parlodel given in a daily dose 5 mg for 7 days in menopausal hypertensive women lowered a significant fall in arterial pressure, blood concentrations of aldosteron, prolactin, aroused dopamine and urinary sodium excretion (p < 0.01). Similar were the changes in hypertensive women at reproductive age with hypothalamic syndrome (n = 8). In such women free of hypothalamic impairment the changes did not occur (n = 10). A significant positive correlation was found between serum levels of prolactine and estradiol in all the hypertensive women in menopause. CONCLUSION: Deficiency of dopaminergic activity in menopause is induced by hypoestrogenemia correlating with serum levels of prolactin. This deficiency was identified in hypertensive menopausal women by the results of acute and prolonged tests with dopamine mimetic--parlodel.

[Redergin treatment of hypertensive menopausal women]. / Opyt primeneniia redergina u bol'nykh arterial'noi gipertoniei klimaktericheskogo perioda.

AIM: To assess a hypotensive effect of redergin (dihydroergotoxin)--agonist of dopaminergic receptors--in monotherapy (4.5-6 mg/day) and in combination with enalapril and amlodipin (10 mg/day). MATERIAL AND METHODS: Redergin in monotherapy or combined therapy was given to 106 hypertensive women in pre- or postmenopause and 24 hypertensive women of reproductive age. Antihypertensive effect was assessed by changes in arterial pressure, frequency and severity of hypertensive crises, diuresis, clinical symptoms of menopausal syndrome. RESULTS: A significant fall in arterial pressure, intensive diuresis, less frequent or absent hypertensive crises, relief of menopausal symptoms were observed on day 10-14 of redergin monotherapy of menopausal patients with mild hypertension and in combined treatment of menopausal women with moderate and severe hypertension. CONCLUSION: Antihypertensive and diuretic effect of redergin confirm a pathogenetic role of deficient dopaminergic activity in development of menopausal hypertension.

[The effect of different factors on cardiac rhythm variability in patients with arterial hypertension]. / Vliianie razlichnykh faktorov na variabel'nost' ritma serdtsa u bol'nykh arterial'noi gipertoniei.

The purpose of this study was to evaluate the influence of different factors, among them left ventricular hypertrophy (LVH) on long-term heart rate variability (HRV) in patients with hypertension. 38 patients with arterial hypertension of different genesis were included in the study. Ischemia was excluded in all the patients by the data of clinical and instrumental methods of investigation. LVH data obtained from HRV of 20 healthy subjects was used as control. HRV was evaluated by estimating variations for short intervals of a rhythmogram (VSI). A HRV decrease did not depend on sex, but essentially depended on patients'a age, disease duration and the form of hypertension. A marked tendency leading to the rate variability decrease was observed only in moderate LVH. In cases of original LVH variability data did not differ from those in patients without signs of LVH. Low or marginal HRV was more often observed in patients with essential hypertension and in those with hypertension of endocrine genesis. As far as renal hypertension is concerned low variability was less frequent. There were a lot of factors which affect the change of HRV. The more significant of them were the patients' age, hypertension genesis and form of hypertension. Factors leading to the rate variability decrease were the following age above 40, endocrine or essential hypertension and moderate form of hypertension.

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.)

[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.

[Various aspects of surgical treatment of vasorenal hypertension]. / Nekotorye aspekty khirurgicheskogo lecheniia vazorenal'noi gipertenzii.

The results of examination and treatment by surgery of 103 patients with vasorenal hypertension are analysed. Retromboses and restenoses of the reconstructed renal arteries and grafts and uncorrected hyperaldosteronism were the most frequent causes of the poor results. Adequate reconstruction of the renal arteries leads to correction of hyperaldosteronism in patients with normal or high activity of plasma renin. Low-renin secondary hyperaldosteronism in patients with vasorenal hypertension is an indication for simultaneous correction.

[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.

[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.

[A method of portalizing the venous blood flow of the left adrenal gland]. / Sposob portalizatsii venoznogo krovotoka levogo nadpochechnika.

The authors, having studied the long-term results of the operation of creating the renoportal venous anastomoses in patients with severe and malignant course of arterial hypertension, revealed anastomotic thrombosis in presence of hypotensive effect. Developed in the experiment and employed in 7 patients was the technique of dosaged narrowing the central left adrenal vein with the aim of achieving its thrombosis, inclusion of the collateral routes of the left adrenal blood outflow into the system of the portal vein and inactivation of aldosterone in the liver.

[Morphofunctional characteristics of endocrine nephropathy in primary aldosteronism]. / Morfofunktsional'naia kharakteristika éndokrinnoi nefropatii pri pervichnom al'dosteronizme.

Tubular functions and the state of renal parenchyma were evaluated in 45 patients with primary aldosteronism (PA) in order to assess morphological and functional characteristics of PA-associated endocrine nephropathy. Data on acid excretion and concentration activities were compared to morphologic findings in renal biopsy specimens, obtained at adrenalectomy. It is demonstrated that endocrine nephropathy may be manifested clinically in two ways: 1) increased secretion combined with a reversibly depressed maximum osmotic urinary concentration; and 2) persistent depression of both functions. The first variant can be seen in cases of high aldosteronemia, marked hypokalemia and recent disease. The morphological substrate of these disorders is hypokalemic tubulopathy, reflected in tubular epithelium vacuole dystrophy of varying degrees. The other variant is seen in cases of moderate aldosteronemia and hypokalemia and long duration of the disease, involving severe hypertension. The morphologic substrate of these tubular disorders is nephropathy with a marked tubulo-interstitial component (chronic tubulo-interstitial nephritis).

[Clinico-morphologic characteristics of 2 tumor forms of primary hyperaldosteronism]. / Kliniko-morfologicheskaia kharakteristika dvukh opukholevykh form pervichnogo gipera'ldosteronizma.

Unilateral adrenalectomy was performed in 32 patients with primary hyperaldosteronism due to tumour of the adrenal gland and with arterial hypertension (AH) of various degree of severity. Stable normalization of AH occurred in 14 patients and in 18 its course improved. The results of a retrospective analysis of a hypotensive effect, the morphological picture of the removed adrenal and the findings of clinico-biochemical and instrumental study made it possible to establish preoperatively the diagnostic criteria for the identification of two tumorous forms of primary hyperaldosteronism: aldosterone-producing adenoma proper and the tumorous form of adrenocortical hyperplasia. They have different pathogenesis and postadrenalectomy hypotensive effect.

[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.

[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.

[Evaluation of the hypotensive effect of unilateral adrenalectomy in patients with low-renin hyperaldosteronism]. / Otsenka gipotenzivnogo éffekta odnostoronnei adrenlaéktomii u bol'nykh s nizkoreninovym giperal'dosteronizmom.

The antihypertensive effect of unilateral adrenalectomy was analyzed in 19 patients with arterial hypertension and primary hyperaldosteronism diagnosed by way comparing clinical findings, a degree of hypokalemia, activity of plasma renin and aldosterone concentration and CT data. A follow-up period after operation was 8-14 mos. Clinical and biochemical findings were compared with the results of morphological investigation of the adrenal glands and kidneys. An antihypertensive postoperative effect was observed in 12 patients: good in 6, moderate in 6, the absence of an antihypertensive effect in 7. Different forms of adrenocortical hyperplasia revealed during histomorphological investigation, endocrine nephropathy of various degree and vascular changes of hypertensive genesis in the renal parenchyma were discussed as causes of residual hypertension.

[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.

[Effect of a beta 2-blocker on the adrenergic receptors of lymphocytes in hypertension]. / Deistvie beta 2-blokatora na adrenergicheskie retseptory limfotsitov pri gipertonicheskoi bolezni.

A short-term effect of propranolol on beta 2-adrenoceptor density in mononuclear lymphocytes was studied in 15 male patients with essential hypertension. According to receptor density alterations the hypertensive subjects were divided into two groups. In the first group lymphocyte beta 2-receptor density increased substantially (3 times, on the average). Propranolol had a weak antihypertensive effect in this group, with the initially low plasma renin activity remaining unchanged after the treatment. The patients of the second group, on the contrary, revealed features of sympathetic hyperactivity and a decrease (2 times on the average) in lymphocyte beta 2-receptor density. Propranolol administration caused a decline in the initially normal or elevated plasma renin activity as well as in systolic arterial blood pressure and heart rate.

[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.