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British Heart Journal logoLink to British Heart Journal
. 1981 Oct;46(4):404–409. doi: 10.1136/hrt.46.4.404

Correction of altered noradrenaline reactivity in essential hypertension by indapamide.

M Grimm, P Weidmann, A Meier, G Keusch, W Ziegler, Z Glück, C Beretta-Piccoli
PMCID: PMC482668  PMID: 7295437

Abstract

Fourteen patients with untreated mild to moderate essential hypertension had on average an abnormally high cardiovascular reactivity to exogenous noradrenaline and angiotension II, while plasma noradrenaline, renin activity, exchangeable body sodium, and blood volume were normal. Treatment with a low dose of indapamide (2.5 mg/day) for six weeks decreased blood pressure by 10% in these hypertensive patients but not in 13 normal control subjects. Plasma or blood volume and exchangeable sodium were not changed significantly; nevertheless, the latter, and body weight, tended to be decreased slightly. Though a mild reduction in extracellular sodium in both normal and hypertensive subjects appears possible, it may not per se fully explain indapamide's blood pressure-lowering effect in essential hypertension. Indapamide induced a mild decrease in angiotensin II pressor responsiveness in normal or hypertensive subjects, but a possible depressor influence from this change was probably antagonised by a concomitant pronounced increase in plasma renin activity. In hypertensive patients, the abnormally high noradrenaline reactivity was corrected by indapamide without an accompanying increase in endogenous plasma noradrenaline levels. Indapamide-induced changes in blood pressure correlated with those in noradrenaline pressor dose. It was concluded, therefore, that indapamide may decrease blood pressure in essential hypertension at least in part by lowering an abnormally high cardiovascular noradrenaline reactivity without causing an equivalent increase in adrenergic nervous activity.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chinn R. H., Düsterdieck G. The response of blood pressure to infusion of angiotensin II: relation to plasma concentrations of renin and angiotensin II. Clin Sci. 1972 Apr;42(4):489–504. doi: 10.1042/cs0420489. [DOI] [PubMed] [Google Scholar]
  2. Da Prada M., Zürcher Simultaneous radioenzymatic determination of plasma and tissue adrenaline, noradrenaline and dopamine within the femtomole range. Life Sci. 1976 Oct 15;19(8):1161–1174. doi: 10.1016/0024-3205(76)90251-4. [DOI] [PubMed] [Google Scholar]
  3. Folkow B. The haemodynamic consequences of adaptive structural changes of the resistance vessels in hypertension. Clin Sci. 1971 Jul;41(1):1–12. doi: 10.1042/cs0410001. [DOI] [PubMed] [Google Scholar]
  4. Grimm M., Weidmann P., Keusch G., Meier A., Glück Z. Norepinephrine clearance and pressor effect in normal and hypertensive man. Klin Wochenschr. 1980 Nov 3;58(21):1175–1181. doi: 10.1007/BF01478873. [DOI] [PubMed] [Google Scholar]
  5. Hollenberg N. K., Chenitz W. R., Adams D. F., Williams G. H. Reciprocal influence of salt intake on adrenal glomerulosa and renal vascular responses to angiotensin II in normal man. J Clin Invest. 1974 Jul;54(1):34–42. doi: 10.1172/JCI107748. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. McGiff J. C., Quilley J. Prostaglandins, kinins and the regulation of blood pressure. Clin Exp Hypertens. 1980;2(3-4):729–740. doi: 10.3109/10641968009037139. [DOI] [PubMed] [Google Scholar]
  7. Philipp T., Distler A., Cordes U. Sympathetic nervous system and blood-pressure control in essential hypertension. Lancet. 1978 Nov 4;2(8097):959–963. doi: 10.1016/s0140-6736(78)92526-6. [DOI] [PubMed] [Google Scholar]
  8. Schalekamp M. A., Lebel M., Beevers D. G., Fraser R., Kolsters G., Birkenhäger W. H. Body-fluid volume in low-renin hypertension. Lancet. 1974 Aug 10;2(7876):310–311. doi: 10.1016/s0140-6736(74)91691-2. [DOI] [PubMed] [Google Scholar]
  9. Sealey J. E., Gerten-Banes J., Laragh J. H. The renin system: Variations in man measured by radioimmunoassay or bioassay. Kidney Int. 1972 Apr;1(4):240–253. doi: 10.1038/ki.1972.34. [DOI] [PubMed] [Google Scholar]
  10. Thurston H., Laragh J. H. Prior receptor occupancy as a determinant of the pressor activity of infused angiotensin II in the rat. Circ Res. 1975 Jan;36(1):113–117. doi: 10.1161/01.res.36.1.113. [DOI] [PubMed] [Google Scholar]
  11. Tobian L., Jr A viewpoint concerning the enigma of hypertension. Am J Med. 1972 May;52(5):595–609. doi: 10.1016/0002-9343(72)90051-4. [DOI] [PubMed] [Google Scholar]
  12. Weber P. C., Siess W., Scherer B. Possible significance of renal prostaglandins in essential hypertension. Clin Exp Hypertens. 1980;2(3-4):741–760. doi: 10.3109/10641968009037140. [DOI] [PubMed] [Google Scholar]
  13. Weidmann P., Beretta-Piccoli C., Ziegler W. H., Keusch G., Glück Z., Reubi F. C. Age versus urinary sodium for judging renin, aldosterone, and catecholamine levels: studies in normal subjects and patients with essential hypertension. Kidney Int. 1978 Dec;14(6):619–628. doi: 10.1038/ki.1978.171. [DOI] [PubMed] [Google Scholar]
  14. Weidmann P., Endres P., Siegenthaler W. Plasma renin activity and angiotensin pressor dose in hypertension correlation and diagnostic implications. Br Med J. 1968 Jul 20;3(5611):154–156. doi: 10.1136/bmj.3.5611.154. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Weidmann P., Grimm M., Meier A., Glück Z., Keusch G., Minder I., Beretta-Piccoli C. Pathogenic and therapeutic significance of cardiovascular pressor reactivity as related to plasma catecholamines in borderline and established essential hypertension. Clin Exp Hypertens. 1980;2(3-4):427–449. doi: 10.3109/10641968009037123. [DOI] [PubMed] [Google Scholar]
  16. Weidmann P., Hirsch D., Beretta-Piccoli C., Reubi F. C., Ziegler W. H. Interrelations among blood pressure, blood volume, plasma renin activity and urinary catecholamines in benign essential hypertension. Am J Med. 1977 Feb;62(2):209–218. doi: 10.1016/0002-9343(77)90316-3. [DOI] [PubMed] [Google Scholar]
  17. Weidmann P., Keusch G., Flammer J., Ziegler W. H., Reubi F. C. Increased ratio between changes in blood pressure and plasma norepinephrine in essential hypertension. J Clin Endocrinol Metab. 1979 May;48(5):727–731. doi: 10.1210/jcem-48-5-727. [DOI] [PubMed] [Google Scholar]
  18. Weidmann P. Recent pathogenic aspects in essential hypertension and hypertension associated with diabetes mellitus. Klin Wochenschr. 1980 Oct 1;58(19):1071–1089. doi: 10.1007/BF01476878. [DOI] [PubMed] [Google Scholar]
  19. Weidmann P., de Chatel R., Schiffmann A., Bachmann E., Beretta-Piccoli C., Reubi F. C., Ziegler W. H., Vetter W. Interrelations between age and plasma renin, aldosterone and cortisol, urinary catecholamines, and the body sodium/volume state in normal man. Klin Wochenschr. 1977 Aug 1;55(15):725–733. doi: 10.1007/BF01476959. [DOI] [PubMed] [Google Scholar]

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