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PubMed · 2856823

Renal response to converting enzyme blockade.

Abstract

To investigate the renal actions of the converting enzyme inhibitor enalaprilic acid, incremental doses of this drug were infused into the renal artery of hypertensive patients just before renal angiography. One group (n = 6) received doses of 0.1, 0.3 and 1 microgram/kg per min, while in another group (n = 7) doses of 1, 3 and 10 micrograms/kg per min were given. Each dose was infused for 10 min, at the end of which renal blood flow was assessed by means of xenon-washout. At the same time, blood was sampled from the renal artery and vein for determination of converting enzyme, renin and angiotensin II. Enalaprilic acid caused a dose-related suppression of converting enzyme activity, which was maximal at a dose of 1 microgram/kg per min; arterial levels fell more steeply than venous ones. Angiotensin II disappeared in parallel with the drop in converting enzyme. Renal blood flow, on the other hand, began to increase only when 3 micrograms/kg per min was given, and no further changes occurred with the highest dose. Intra-arterial blood pressure fell only when the highest dose was given. Renin secretion tended to increase, but changes were not statistically significant. It is concluded that systemic suppression of converting enzyme is needed for renal vasodilatation to occur. However, the renal vascular response comes well before blood pressure falls.

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BibTeXRIS

P W de Leeuw, P N van Es, M Looman, W H Birkenhäger. 1985. Renal response to converting enzyme blockade.. https://pubmed.ncbi.nlm.nih.gov/2856823/

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BACKGROUND: Since the report that hypertension associated with Wilms tumor (WT) may be renin-induced, no larger series than 13 patients have been published. Nevertheless, angiotensin converting enzyme (ACE) inhibitors have become treatment of choice for hypertension in WT patients. The purpose of this study was to investigate the correlation between plasma renin levels and blood pressure in a larger cohort of WT patients. PROCEDURE: In this retrospective, single-center study, data on blood pressure and plasma renin were analyzed in 86 WT patients treated according to the consecutive SIOP protocols 6, 9, 93-01, and 2001. RESULTS: At diagnosis, 47 WT patients suffered from hypertension (55%). In 31 of these patients plasma renin levels were analyzed; increased plasma renin levels were found in 25/31 patients (81%). In contrast, normal plasma renin levels were measured in 8/13 of the patients with a normal blood pressure (P = 0.012). Twenty-eight children received antihypertensive treatment before surgery, in 25 of them blood pressure normalized before surgery. Blood pressure was normal directly after surgery in all patients but 4, in whom blood pressure recovered to normal within a few weeks. CONCLUSIONS: This retrospective study shows that hypertension in WT patients is associated with elevated plasma renin levels, indicating that ACE inhibitors may be a good therapeutic option in at least a subset of WT patients with hypertension before nephrectomy.

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