Familial hyperpotassemia and hypertension accompanied by normal plasma aldosterone levels: possible hereditary cell membrane defect.

Hypertension and hyperpotassemia that were accompanied by normal plasma aldosterone and low renin levels and were responsive to chlorothiazide administration were found in a 29-year-old patient and two decades later in his 21-year-old son. Their renal function is normal, including response to sodium sulfate, mannitol, and aldosterone infusions. Adrenal insufficiency was excluded. The renin-aldosterone system was proved intact by physiological and pharmacologic stress and angiotensin-II infusion. Also normal were values for blood counts, blood volumes, and erythrocyte and exchangeable body potassium. The postulation of a defective cell membrane impeding potassium influx is supported by the failure of glucose and insulin infusions to substantially reduce hyperpotassemia. In the context of a hereditary disorder (the pedigree, compatible with autosomal dominant inheritance, includes five affected in two generations), hypertension is a second phenotypic character of a single defective pleiotropic gene although its pathogenesis remains unclear.

Pressor response to saralasin (1-sar-8-ala-angiotensin II) bolus injection in hypertensive patients.

A 10 mg bolus of the angiotensin blocker saralasin was injected 113 times in 68 subjects with essential or renovascular hypertension. Ninety percent of injections caused a transient increase in blood pressure, which correlated with plasma renin activity (PRA) (r = -0.54); Mean increase at 2 minutes was 21/13.4 mm Hg (P less than 0.001) and was independent of pre-injection control blood pressure, with a rapid decrease to or below control values thereafter. Thirty-seven subjects were studied on successive days before and after furosemide-induced sodium depletion (152 +/- 26 mEq [SE] sodium loss). In the low renin group, sodium depletion did not change PRA or the magnitude of the pressor response to saralasin, but significantly decreased control MAP by 13 mm Hg (P less than 0.01). In normal and high renin patients, MAP was unchanged after diuresis, but PRA increased significantly and the pressor response was attenuated. The net effect of sodium depletion was to reduce the pressor response to saralasin in all renin subgroups by 9 to 12 mm Hg. Saralasin bolus injection, unlike infusion, saturates available vascular receptors only briefly, eliminating prolonged pressor responses.

Angiotensin blockade in renovascular hypertension: a controlled, prospective study.

Saralasin, a specific competitive inhibitor of angiotensin II, was administered in a controlled, prospective study designed to test the hypothesis that this agent is a useful tool for the detection of renovascular hypertension. 13 patients, 11 with renovascular hypertension and 2 with high-renin essential hypertension, showed a gross, readily apparent decrease in blood pressure after receiving saralasin. 8 patients with essential hypertension and normal or low renin levels exhibited no depressor response to the drug. In the patients with renovascular hypertension, blood pressure response during angiotensin blockade compared favourably with renal vein renin determinations as a predictor of operative results. Because saralasin testing has resulted in few if any falsely positive or negative results when considered as a diagnostic procedure for renin-mediated hypertension, and because it is safe, it may become an ideal initial screening procedure. The saralasin test (either bolus injection or sustained infusion) is completely valid only if the patient is mildly salt-depleted, is not taking other antihypertensive medication, and is genuinely hypertensive at the time of the test.

Mechanisms of hypertension during the acute and intermediate phases of the one-clip, two-kidney model in the dog.

The acute and intermediate onset phases of one-clip, two-kidney hypertension were studied in six conscious dogs. Mean arterial pressure (MAP), cardiac output (CO), total peripheral resistance (TPR), serum renin concentration (SRC), plasma aldosterone (PA) and cumulative sodium and water balance were studied prior to unilateral renal artery constriction, at 2, 10, and 24 hours postconstriction, and daily thereafter for 5 days. At 2 hours postconstriction, MAP, CO, TPR, and SRC were elevated, with unchanged fluid balance. At 10 and 24 hours there was a further rise in CO accompanied by positive fluid-sodium balance, with a slight decrease in MAP, TRP, and SRC. During days 2 and 3, MAP, CO, TPR, and SRC remained elevated and stable in the presence of decreasing fluid-sodium balance to preconstriction levels. During days 4 and 5, MAP, SRC, and fluid-sodium balance remained unchanged, TPR demonstrated a secondary increase, whereas CO decreased to preconstriction values. Sequential changes in PA parallel those of SRC, but were significant only at 2 hours postconstriction. These changes suggest that the increased CO is not totally dependent on fluid-sodium balance, and that CO is not the sole determinant of elevated MAP. The temporal relationship between MAP and SRC throughout the study is consistent with renin-mediated hypertension. The secondary rise of TPR may be due to total body autoregulation and/or increased vascular reactivity to high levels of circulating angiotensin. A unitary renin-angiotensin mechanism, therefore, may be responsible for the induction and maintenance of hypertension in this experimental model.

Treatment of ulcerative colitis with azathioprine.

Azathioprine (Imuran) was administered to seven patients with ulcerative colitis suffering from a relapse which could not be controlled by adrenocortical steroids. In four patients remission started one to two weeks after initiation of antimetabolite therapy. Corticosteroid administration was continued concurrently with azathioprine, but the dosage could be reduced and in one case they were withdrawn.Apart from transient leucopenia in two cases, and transient nausea and vomiting in two, no complications were encountered.