Primary role of renal homografts in setting chronic blood pressure levels in rats

Essential hypertension in blacks: epidemiology, characteristics, and possible roles of racial differences in sodium, potassium, and calcium regulation

Racial differences in the regulation of Na+, K+, and Ca2+ have been shown both at the systemic and cellular levels. These include a higher incidence of "salt sensitivity," lower urinary K+ excretion, lower plasma renin activity, and higher circulating levels of immunoreactive parathyroid hormone and 1.25 dihydroxyvitamin D in blacks than in whites. Blacks exhibit a higher erythrocyte Na+ concentration, coupled with a lower maximal initial reaction velocity of erythrocyte Na,K-ATPase. Blacks also appear to differ from whites in erythrocyte Na+, K+ cotransport and Na-Li countertransport. Moreover, they show a higher activity of the Na(+)-H+ antiport in skin fibroblasts and a greater response of cellular Ca2+ signaling to agonists in serum. Mechanisms linking some of these racial differences in ionic metabolism to the increased propensity of blacks to develop essential hypertension are proposed, and the epidemiology and characteristics of this disease in blacks are reviewed.

Genetic, neurohumoral, and hemodynamic influences on spontaneously hypertensive rat heart development in oculo

To distinguish among genetic, neurohumoral, and hemodynamic explanations for structural and functional differences in the hearts of young spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) control rats, embryonic SHR and WKY rat heart tissue was cultured in the anterior eye chamber of adult SHR and WKY rats. In study 1, atria from E-12 WKY rat embryos grafted into anterior eye chambers of either SHR or WKY host rats achieved a larger size than did SHR grafts by 8 weeks in oculo (2.98 +/- 0.75 and 2.55 +/- 0.32 mm2 vs. 1.80 +/- 0.20 and 2.04 +/- 0.44 mm2). Beating rates did not differ between SHR and WKY rat atria implanted into SHR or WKY host rats. In study 2, ventricles from E-13 embryonic SHR and WKY rat hearts grew to similar size and weight when implanted into SHR or WKY host rats (e.g., SHR hearts, 1.81 +/- 0.32 vs. 1.74 +/- 0.33 mm2; WKY rat hearts, 1.75 +/- 0.29 vs. 2.29 +/- 0.32 mm2). Ventricle grafts from SHR embryos into SHR host rats beat more rapidly (165 +/- 19 beats/min) during weekly measurements than either WKY rat ventricles (92 +/- 9 beats/min in SHR hosts and 99 +/- 9 beats/min in WKY host rats) or SHR ventricles grafted into WKY host rats (109 +/- 7 beats/min, p less than 0.001). In study 3, atria from E-13 SHR and WKY rat embryos were grafted into sympathectomized and intact eye chambers of SHR or WKY host rats. Sympathectomy of the eye chamber compromised growth of grafts into WKY host rats (1.54 +/- 0.24 vs. 0.90 +/- 0.14 mm2) but not SHR hosts (1.54 +/- 0.25 vs. 1.73 +/- 0.24 mm2). Grafts into sympathectomized eye chambers of WKY host rats beat more slowly than grafts into eye chambers with sympathetic innervation intact (282 +/- 14 vs. 202 +/- 14 beats/min); sympathectomy did not alter beating rate of grafts in SHR hosts (266 +/- 14 vs. 255 +/- 18 beats/min). These results suggest that the growth and beating rate of SHR atrial grafts may be less sensitive to sympathetic innervation than WKY rat atrial grafts. In these studies, SHR grafts did not grow larger than WKY heart grafts and did not show an increased intrinsic beating rate, suggesting that the cardiac hypertrophy and increased intrinsic beating rate observed in intact SHR are unlikely to result from direct genetic programming.

Role of the kidney in the pathogenesis of primary hypertension

Primary hypertension in animals and humans probably represents several different pathophysiological states rather than being a uniform nosological entity. Among other factors, renal mechanisms may be primarily and secondarily involved. The availability of genetically homologous animal models for hypertension has greatly promoted studies on the etiology and pathogenesis of high blood pressure disease. In particular, renal transplantation studies between genetically hypertensive and normotensive rats from three different models have provided strong evidence for a primary role of the kidney in genetic hypertension. Other factors, such as vascular, neural, and humoral mechanisms have also been shown to be involved and may be particularly effective in increasing blood pressure, when they act through the kidney. Several functional and biochemical differences have been identified between kidneys from genetically hypertensive and normotensive animals. However, the relative contribution of each of these factors to the development of primary hypertension remains to be determined. Evidence from studies on human renal graft recipients also indicates that, among other factors, the kidney plays an important role in the development of primary hypertension in humans.

Effect of plasma from essential hypertensives on tension of aortic strips

The effect of fractions of plasma from essential hypertensive (n = 27) and normotensive subjects (n = 26) on the tension of aortic strips (n = 27) from normotensive rats was examined. The fractions obtained from hypertensive patients had been shown to increase blood pressure, when injected intravenously in a normotensive rat. In aortic strips the hypertensive fractions elicited a transient relaxation of variable amplitude and subsequently a sustained contraction. The normotensive fractions did not alter tension of the strips significantly. In Ca2+ free medium and after addition of nifedipine hypertensive plasma fractions did not induce a contraction, whereas in Na+ free medium the contraction was not abolished. It is concluded that in the fraction of hypertensive plasma containing substances with a molecular weight in the range of 1000-1500 Da a vasopressor agent with direct actions on arterial smooth muscle is present. The substance probably acts by increasing Ca2+ influx in vascular smooth muscle.

Alterations in blood pressure by derangement of the mechanisms that regulate sodium excretion

Understanding the sequence of events responsible for pressure-related natriuresis and their pathophysiologic alterations may be useful in distinguishing various types of essential hypertension of renal origin. The perturbation of a distal step in the sequence is likely to be reflected in a simple physiologic defect. For instance, pathophysiologic alterations in the medullary production of prostaglandin E2 might directly influence natriuresis and diuresis because of its modulatory effect on tubular reabsorption of sodium and water. Perturbation of more proximal steps in the sequence could influence all the distal events as well. For instance, prostaglandin I2 and endothelium-derived relaxing factor may be produced by the preglomerular vasculature in response to alterations in renal perfusion pressure and may modulate the release of renin from the juxtaglomerular cells. Thus, variations in the production of prostaglandin I2 or endothelium-derived relaxing factor may be reflected by various renal vascular, tubular, and systemic homeostatic events related to the renin-angiotensin system.

Hypertension

An estimated 58 million Americans are at increased risk of morbidity and premature death due to high blood pressure (BP) and require some type of therapy or systematic monitoring. This article focuses on recent advances in our understanding of the pathogenesis of hypertension, new approaches to the diagnosis and treatment of secondary hypertension, and current views of the most appropriate nonpharmacologic and pharmacologic therapy for essential hypertension. In view of the extremely high prevalence of the disorder, emphasis is placed on efficient and cost-effective strategies for diagnosing and managing the hypertensive patient. Recent evidence indicates that nonpharmacologic therapy, including dietary potassium and calcium supplements, reduction of salt intake, weight loss for the obese patient, regular exercise, a diet high in fiber and low in cholesterol and saturated fats, smoking cessation, and moderation of alcohol consumption produces significant sustained reductions in BP while reducing overall cardiovascular risk. Accordingly, nonpharmacologic antihypertensive therapy should be included in the treatment of all hypertensive patients. In persons with mild hypertension, nonpharmacologic approaches may adequately reduce BP, thereby avoiding the expense and potential side effects of drug therapy. In patients with more severe hypertension, nonpharmacologic therapy, used in conjunction with pharmacologic therapy, can reduce the dosage of antihypertensive medications necessary for BP control. Patients treated with nonpharmacologic therapy only should be followed closely, and if BP control is not satisfactory, drug therapy should be added. The large number of drugs available for use in hypertension treatment, coupled with our rapidly expanding knowledge of the pathophysiology of hypertension and of the adverse effects of these drugs in individual patient groups, make it possible to individualize antihypertensive treatment. When used as monotherapy, most agents effectively lower BP in the majority of patients with mild or moderate essential hypertension. Thus, a single agent from one of four classes: diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta-adrenergic blockers, usually provides effective BP control with minimal side effects in most patients. Therapy should be initiated with the agent most likely to be effective in BP lowering and best tolerated. If the initial agent is ineffective at maximal recommended therapeutic doses or has undue side effects, an alternative agent from another class should be tried. When monotherapy is unsuccessful, a second agent, usually of a different mechanism of action, should be

Function of the hypertensive kidney during calcium flux manipulation

Dihydropyridine calcium channel agonists and antagonists elicit exaggerated glomerular and circulatory responses from kidneys isolated from Dahl rats genetically programmed to develop NaCl-induced hypertension (Dahl S rats). These differential responses are further magnified by NaCl loading. In contrast, "chemical sympathectomy" with 6-hydroxydopamine enhances renal vascular responses to calcium channel agonists in a manner that depends on the antecedent dietary NaCl intake, and is independent of genetic predilection to develop NaCl-induced hypertension. These findings are consistent with the hypothesis that aberrations of vascular and perhaps glomerular calcium entry modulation may be determinants of altered renal hemodynamics in NaCl-sensitive hypertension. The latter may be responsible for the enhanced responsiveness to calcium channel antagonists observed in NaCl-sensitive hypertension in humans.

Effects of calcium antagonists on deranged modulation of the renal function curve in salt-sensitive patients with essential hypertension

Two subsets of patients with essential hypertension have been identified based on their sensitivity to dietary sodium intake: the salt-sensitive and the salt-resistant patients. The renal function curve in salt-resistant patients is shifted to higher blood pressure levels but it remains parallel to that of normal subjects. On the contrary, the slope of the renal function curve in salt-sensitive patients is considerably depressed. It is postulated that this derangement may be related to an abnormal relation between sodium intake and sympathetic nervous system activity. It is also postulated that a link exists between abnormalities of sodium and calcium metabolism in hypertension and that reduced renin release, increased sympathetic activity and reduced renal sodium excretion in salt-sensitive patients may be related to a defect in sodium-linked cellular calcium transport. Calcium antagonists revert the derangements in the renal function curve and in renin release in salt-sensitive patients.

Renal disease and the development of hypertension in salt-sensitive Dahl rats

To elucidate the role of the kidneys in the development of hypertension in Dahl salt-sensitive (S), as compared to resistant (R) rats of the JR strain, we analyzed functional and morphological changes before and after the administration of an 8% NaCl diet and the onset of hypertension. The diet was begun at six weeks of age and was continued until 12 weeks of age. At six weeks, blood pressure was not different between S and R rats. Hypertension occurred in S rats receiving the 8% NaCl diet at week 8, and in S rats receiving 0.9% NaCl at week 10. Albuminuria and proteinuria were found in S rats prior to the 8% NaCl diet and progressed regardless of diet. Electron microscopy of glomeruli revealed segmental loss of epithelial foot processes in S rats at six weeks prior to the 8% NaCl diet. Mesangial widening, arteriolar myo-intimal cell hyperplasia and interstitial fibrosis occurred in all S rats. Inulin and PAH clearances in S rats decreased with time, the changes being accelerated by the 8% NaCl diet. Micropuncture of S and R rats prior to the 8% NaCl diet revealed no glomerular hypertension in S rats. The number of glomeruli in S and R rats were not different. We conclude that prehypertensive S rats of the JR strain already have albuminuric glomerular disease not associated with reduced number of glomeruli or glomerular hypertension. The renal pathology is accelerated once hypertension develops. A lower NaCl intake delays, but does not prevent renal disease in S rats.

Papillary collecting tubule synthesis of prostaglandin E2 in Dahl rats

Isolated kidneys of Dahl salt-sensitive rats (DS) excrete sodium less readily than those of Dahl salt-resistant rats (DR). The collecting tubule is an important source of papillary prostaglandin E2 and is a site of significant sodium reabsorption. We cultured renal papillary collecting tubule cells from 5-week-old, prehypertensive DS and DR on a low salt diet and also after 14 weeks of high salt feeding, and we measured prostaglandin E2 synthetic capacity. Unstimulated renal papillary collecting tubule cells from 5-week-old DS produced 62 +/- 5% less prostaglandin E2 than did comparable cells from DR (p less than 0.001). The cells from DS also synthesized less prostaglandin E2 after stimulation with the calcium ionophore A23187 (67 +/- 6% of control; p less than 0.001) or the addition of exogenous arachidonate (74 +/- 7% of control; p less than 0.01). Urinary prostaglandin E2 excretion was also diminished in the 5-week-old DS compared with their salt-resistant counterparts (18.1 +/- 1.3 vs 23.9 +/- 1.7 ng/24 hr; p less than 0.025). After high salt feeding, the DS became hypertensive but the DR remained normotensive. Renal papillary collecting tubule cells cultured from these DS continued to produce less prostaglandin E2 than those from control rats, both in the basal state (60 +/- 12% of control; p less than 0.09) and after stimulation with ionophore (62 +/- 2% of control; p less than 0.002). In these older animals, the DS continued to underexcrete prostaglandin E2 compared with the DR (29.7 +/- 3.2 vs 42.2 +/- 6.1 ng/24 hr; p less than 0.08). The underproduction of prostaglandin E2 in the papillary collecting tubule of DS may play a role in their inadequate renal natriuretic capacity and contribute to the onset and maintenance of salt-induced hypertension in this strain.

Effect of hypertensive plasma on Ca2+ transport in human neutrophils

The effects of plasma fractions from essential hypertensives (n = 17) and normotensives (n = 17) on Ca2+ transport in permeabilised human neutrophils were studied using an ion-selective electrode. The plasma fractions were obtained by gel filtration and contained substances with a molecular weight in the range of 1000-1500 Da. When isolated from essential hypertensives, this fraction had been shown to increase blood pressure after intravenous injection in the rat. The rate of Ca2+ uptake by permeabilised neutrophils after addition of extracellular Ca2+ was significantly accelerated during incubation of the cells with the hypertensive fraction (855.9 +/- 812.3% vs 218.0 +/- 294.3% of the control value, P less than 0.05). In a suspension with intact neutrophils hypertensive plasma fractions (n = 7) caused an increase of extracellular pCa by 0.479 +/- 0.115 (P less than 0.01), whereas the normotensive fractions did not change pCa significantly. It is concluded that the hypertensive plasma fraction increases Ca2+ accumulation in subcellular particles. Additionally the Ca2+ influx through the plasma membrane is increased by the circulating hypertensive factor.

Papillary collecting tubule responsiveness to atrial natriuretic factor in Dahl rats

There is evidence that atrial natriuretic factor (ANF) has an action in the inner medullary collecting duct. In addition, the prehypertensive Dahl salt-sensitive (S) rat has an intrinsic tendency toward less natriuresis than the Dahl salt-resistant (R) rat has when challenged with ANF. To test the hypothesis that renal papillary collecting tubule cells from prehypertensive S rats might be genetically less responsive to ANF, S and R cells were grown in culture and studied for responsiveness to ANF by measurement of cyclic nucleotide responses. There was a concentration-dependent effect of ANF on renal papillary collecting tubule cell synthesis of intracellular cyclic guanosine 3',5'-monophosphate (cGMP) in both strains. However, the S cells were hyporesponsive compared with the R cells (p less than 0.002, by analysis of variance). Likewise, in response to Na nitroprusside, the S cells were hyporesponsive compared with the R cells as measured by intracellular cGMP accumulation (p less than 0.03, by analysis of variance). Arginine vasopressin stimulated intracellular cAMP equally in both strains. Also, ANF equally enhanced intracellular cGMP in glomerular mesangial cells from S and R rats, indicating possible specificity of the reduced responsiveness to ANF to the distal nephron of S rats. Plasma ANF levels had a slight tendency to be higher in prehypertensive S rats than in R rats (p = 0.088, by t test). These results suggest that the papillary collecting duct of Dahl S and R rats may differ in guanylate cyclase activity. This difference may partially explain the impaired natriuretic responses of S rats and could represent a factor contributing to the development of salt-sensitive hypertension.

Cellular calcium metabolism in primary hypertension

Several disturbances of cellular Ca2+ metabolism have been described in essential hypertension and in the spontaneously hypertensive rat. Possibly the elevation of intracellular free Ca2+ concentration in arterial smooth muscle cells is one important step in the pathogenesis of primary hypertension. In most studies a decreased energy-dependent Ca2+ transport has been proposed as a mechanism. However, disturbances in cellular Ca2+ metabolism, which can be exclusively ascribed to essential hypertension, have not yet been found. The cause of altered cellular Ca2+ transport in primary hypertension may either be a genetically determined defect of membrane transport or a still-unidentified humoral factor.

The effect of antihypertensive treatment on the circulating hypertensive factor in the spontaneously hypertensive rat

To elucidate the role of circulating hypertensive factors in the spontaneously hypertensive rat and the effects of antihypertensive treatment on the circulating hypertensive factor, cross circulation was performed in 54 couples of spontaneously hypertensive and normotensive rats. In normotensive rats cross-circulated with untreated spontaneously hypertensive rats mean arterial pressure increased by 20.9 +/- 12.2 mm Hg (p less than 0.01). Increases in mean arterial pressure were also obtained by cross-circulation with spontaneously hypertensive rats pretreated with propranolol, furosemide, and nifedipine. Mean arterial pressure was not changed by cross circulation after pretreatment of the spontaneously hypertensive rats with alpha methyldopa. It is concluded that in this strain of spontaneously hypertensive rats a circulating hypertensive factor exists, the secretion of which can be suppressed by the centrally acting drug, alpha methyldopa. Therefore either the central nervous system may take part in the regulation of the factor or the factor may be synthetized in the central nervous system.

Dietary sodium intake and urinary dopamine and sodium excretion during the course of blood pressure development in Dahl salt-sensitive and salt-resistant rats

Recent studies have suggested that dopamine (DA) formed within the kidney may play an important role in promoting sodium excretion, and that renal production and excretion of DA is determined by dietary sodium intake. Inasmuch as increased sodium consumption produces hypertension in Dahl salt-sensitive (DS) rats but not in Dahl salt-resistant (DR) rats, the present study was designed to examine the relationship between sodium consumption and urinary excretion of DA in these rats. DS and DR rats were placed on either high sodium chloride (8%) or low sodium chloride (0.4%) diets at 4 weeks of age and their systolic blood pressure (SBP), urine volume, urinary sodium and catecholamine excretion were measured once every week for the next 4 weeks. High sodium chloride diet increased SBP in DS rats at 6 weeks of age and SBP continued to rise until they were 8 weeks old. The SBP of DR rats did not reach hypertensive levels when they were given high sodium chloride diet. The SBP of DS rats on low sodium chloride diet was significantly higher than DR rats on the same diet. The urinary DA excretion increased with age in all four groups of rats and was similar when they were 8 weeks old. However, both DS and DR rats on high sodium chloride diet excreted greater amounts of sodium and had increased urine volume compared to the DS and DR rats on low sodium chloride diet. There were no significant differences in urinary NE or E excretion in these four groups of rats. Kidney levels of DA and NE were significantly lower in DS compared to DR rats on high sodium chloride diet. These results show that although there are no differences in urinary DA excretion between rats on low and high sodium intake, both DS and DR rats on high sodium chloride diet are able to exhibit a natriuretic response. The DS rats eliminate sodium at the expense of an elevated SBP whereas DR rats stay normotensive. Therefore, it appears that alterations in mechanisms controlling renal vascular resistance rather than sodium excretion are responsible for the development of hypertension in DS rats.

Sodium handling by the Sabra hypertension prone (SBH) and resistant (SBN) rats

The acute and chronic renal handling of salt was evaluated in age matched Sabra hypertension-prone (SBH) and hypertension-resistant (SBN) rats. Acute oral (4 ml/100 g) and intravenous (3.3 ml/100 g) isotonic saline loading in unanesthetized normotensive animals maintained on normal diet elicited a significantly lesser diuretic and natriuretic response in SBH than in SBN. Intermittent studies in metabolic cages in rats aged 5 to 21 weeks showed that both strains consumed similar amounts of salt but that SBH excreted significantly less urinary sodium than SBN (F = 40, p less than 0.001). Twenty four hour clearance studies showed a similar filtered sodium load in the two strains but a lower total and fractional sodium excretion in SBH, suggesting increased tubular reabsorption. Under conditions of water diuresis, free water clearance was similar in the two strains, suggesting the site for disparate tubular sodium handling to be distal to the thick medullary ascending limb of the loop of Henle. Acute oral saline loading and long term studies in metabolic cages in rats prepared with deoxycorticosterone-acetate (doca) and salt showed no significant differences in sodium excretion between hypertensive SBH and normotensive SBN. These findings indicate disparate renal sodium handling between SBH and SBN rats, already apparent before the onset of hypertension, which dissipates during doca-salt treatment.

Abnormal renal sodium handling in essential hypertension. Relation to failure of renal and adrenal modulation of responses to angiotensin II

This study assessed renal sodium handling in a group of patients with essential hypertension in whom control of the renal blood supply and aldosterone release by angiotensin II is abnormal ("non-modulating") because of recent evidence that these patients have sodium-sensitive hypertension. Sixty-one patients were studied, 25 as balance was achieved with a daily sodium intake of 10 meq and 36 after a shift from a 10 meq to 200 meq sodium intake for five days. Renal and adrenal responsiveness to angiotensin II was assessed by measurement of para-aminohippurate clearance and plasma aldosterone prior to and during the infusion of 3 ng/kg per minute of angiotensin II, to identify the non-modulator group (n = 32). The half-time of the exponential function relating sodium excretion to time during the three to five days when external balance was being achieved with a 10 meq sodium intake was 23.9 +/- 0.3 hours in 60 normal subjects, 24.5 +/- 1.8 hours in the patients with essential hypertension in whom renal responsiveness to angiotensin II was normal, and prolonged (p less than 0.001) to 36.6 +/- 2.1 hours in the non-modulating patients. A prolonged half-time suggests that, with a shift to a high sodium intake, more time will be required to achieve external sodium balance and at the expense of more retained sodium. During the shift from a 10 to 200 meq sodium intake, the non-modulator group showed a delayed rate at which external sodium balance was achieved, greater cumulative positive sodium balance, more weight gain, and a greater frequency of blood pressure rise. The abnormality in the rate at which external sodium balance is achieved in non-modulation results in a difference in total body sodium that varies with sodium intake and that may well contribute to, or cause, sodium-sensitive hypertension.

What's new in cellular cation exchange and humoral factors in primary hypertension?

In essential hypertension abnormalities of cellular Na+ and Ca++ handling have been described. The latter disturbance probably offers an explanation for the increased vasoconstriction in essential hypertension. The etiology of those disturbances in cellular Na+ and Ca++ metabolism may be related to genetic disturbances of membrane transport, or to a humoral factor influencing cellular cation metabolism.

Prostaglandins and hypertension

Generalized arteriolar vasoconstriction is the dominant element in essential hypertension. Although the proximate cause of this process remains elusive, several lines of evidence suggest that abnormalities in prostaglandin and thromboxane metabolism may contribute to the pathophysiology of hypertension. Diminished endogenous synthesis of vasodilator prostaglandins and enhanced formation of the vasoconstrictor thromboxane may participate in this process, particularly in the kidney. The use of nonsteroidal anti-inflammatory drugs, which inhibit prostaglandin synthesis, may aggravate blood pressure control, especially when used with certain diuretics and other antihypertensive medications. Attempts to enhance endogenous synthesis of prostaglandin metabolites expressing potent vasodilator properties by supplementation of the diet with polyunsaturated fatty acids may provide a new strategy to control blood pressure.

Salt and hypertension

Studies comparing different communities have suggested that the amount of salt in the diet may play an important role in determining blood pressure levels within a particular community. Intervention studies have also suggested that salt intake may play an important role in determining blood pressure levels in man. In animals, where more clearcut experiments can be done, an increase in salt intake both in inherited forms of hypertension and experimental hypertension causes a further rise in blood pressure. Recent work has suggested that this rise in blood pressure could be related to an inherited or imposed defect in the kidney's ability to excrete sodium, which will give rise to greater compensatory mechanisms to overcome the sodium retention. These compensatory mechanisms might eventually be responsible for the development of high blood pressure. In patients who have already developed high blood pressure, restricting the amount of salt in the diet does cause a fall in blood pressure in many patients. However, short-term reduction of salt intake in normotensive subjects causes little, if any, fall in blood pressure. The effectiveness of short term salt restriction in lowering blood pressure in adults therefore appears to be related to the severity of the high blood pressure and, probably more directly, to the suppression of the renin system that occurs as blood pressure rises.

Decreased total and active urinary kallikrein in normotensive Dahl salt susceptible rats

Abnormalities in the kallikrein-kinin system have been found in human and animal models of essential hypertension. The purpose of this study is to assess the kallikrein-kinin system in normotensive Dahl salt sensitive (S) and salt resistant (R) rats on a zero sodium diet. Urinary kallikrein was measured at 7 and 12 wk of age by different techniques. When kallikrein activity was assessed, by a kininogenase assay, S rats excreted 66% (P less than 0.001) and 75% (P less than 0.01) as much kallikrein as R rats at 7 and 12 wk of age. Using an artificial substrate method (Kabi S-2266), S rats excreted 30% (P less than 0.001) and 56% (P less than 0.05) as much kallikrein as R rats at 7 and 12 weeks, respectively. Using a technique to measure total kallikrein, S rats excreted 53% (P less than 0.001) and 65% (P less than 0.05) as much kallikrein as R rats at 7 and 12 wk of age. Normotensive S rats failed to increase maximally kallikrein activity or total kallikrein when the diet was switched from a .4% to a .0064% sodium chloride diet. There was no difference in inhibitors, as measured by the recovery of purified kallikrein added to S and R urine (56 +/- 21% vs. 53 +/- 13%). Km values for S and R urinary kallikrein were similar (3.1 +/- .5 X 10(-5) vs. 2.6 +/- .5 X 10(-5) M/liter). Trypsin-activatable kallikrein was equivalent in the S and R rats on the .0064% and .4% sodium chloride diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanisms of posttransplant hypertension

Posttransplant hypertension is an important risk factor for cardiovascular mortality and graft function. We performed metabolic studies in 35 hypertensive patients with well-maintained graft function on maintenance immunosuppressive drugs and in 17 normotensive control transplant recipients. The group of hypertensive recipients were characterized by increased peripheral plasma renin activity, lack of change in blood pressure in response to salt loading and restriction, and by increased peripheral and renal resistance. In contrast, on the same protocol in a group of patients with essential hypertension, blood pressure fell significantly on a low-salt intake. Peripheral resistance in hypertensive transplant recipients fell in response to saline loading, in contrast to the effects in normotensive transplant recipients. Hypertensive patients with retained native kidneys as compared to those who had these removed prior to transplant, but were still hypertensive, differed only with regard to reduced renal plasma flow in the former group. These data are consistent with a predominantly renin-dependent hypertension in these renal transplant recipients. When bilateral nephrectomy or repair of graft renal artery stenosis is being considered, response to captopril may offer a means of selection; acute renal failure on captopril suggests functionally significant renal artery stenosis.

The role of renal catecholamines in hypertension

We have found increased renal alpha 2-adrenoceptor density and a defect in prostaglandin and parathyroid stimulated adenylate cyclase in two genetic forms of rat hypertension. Changes in serum calcium and parathyroid hormone (PTH) levels suggest biologic significance to this defective adenylate cyclase response. Our hypothesis is that one or more of these defects contribute to excess renal retention of sodium and increase vascular resistance of genetically hypertensive rats and humans with essential hypertension who have similar abnormalities of calcium and PTH.

The morphology and antihypertensive effect of renomedullary interstitial cells derived from Dahl sensitive and resistant rats

The renomedullary interstitial cell (RIC) has been implicated in the antihypertensive action of the kidney. This cell has been isolated in tissue culture and shown to have an antihypertensive action in several models of experimental hypertension. Morphometric studies of RIC in vivo from Dahl rats sensitive and resistant to the hypertensive effects of high-salt diets indicate major differences between the RICs. These cells were therefore isolated from salt-sensitive and salt-resistant strains of rat, grown, and maintained in tissue culture. Major morphologic differences between the two cell lines were noted and persisted for multiple tissue culture passages. The cells from resistant animals were larger and had more lipid granules. These differences were similar to those seen in vivo. In short-term experiments these cells were compared for their antihypertensive effect. The two cell lines were injected subcutaneously into two groups of hypertensive recipient rats, one group of Dahl salt-sensitive rats on a high-salt diet and one group of Wistar rats subjected to the one-kidney, one-clip Goldblatt procedure. In both cases differences were noted between the cell lines. These data support the concept that differences between the Dahl salt-sensitive and salt-resistant rats may be related to variations in their RIC.

Sodium transport inhibition, cell calcium, and hypertension. The natriuretic hormone/Na+-Ca2+ exchange/hypertension hypothesis

Sodium plays a critical role in the etiology of essential hypertension, but the mechanism by which excess dietary sodium actually leads to the elevation of blood pressure is not understood. The hypothesis described shows how an excessive sodium load can lead to the development of hypertension. The underlying factor must be a genetic or acquired deficiency or limitation in renal sodium excretion that may be undetectable by standard renal function tests. The resultant tendency towards sodium, water, and extracellular fluid volume expansion is compensated by the secretion of a natriuretic hormone that promotes sodium excretion by inhibiting sodium pumps in the kidney tubule cells. The hormone also inhibits sodium pumps in other cells, including vascular smooth muscle cells, causing intracellular sodium to increase. Then, because the vascular smooth muscle cells contain a Na+-Ca2+ exchange transport system in their plasma membranes, more calcium than normal is delivered to these cells. This causes the increased contractility and reactivity that underlies the increased vascular tone and peripheral vascular resistance that elevates the blood pressure.

Alpha 1- and alpha 2-adrenoceptor binding in the Dahl rat model of hypertension

Dahl sensitive rats on a high salt diet (DSH group) developed significant elevations in blood pressure (BP). Sensitive rats maintained on a low salt diet (DSL group) and Dahl resistant rats on a high or low salt diet (DRH and DRL groups, respectively) remained normotensive. The DSH and DRH groups displayed a lower density of alpha 2-adrenoceptors (as measured with [3H]-clonidine) in the cerebral cortex than normotensive DSL and DRL groups. In contrast, the density of alpha 2-adrenoceptors in the medulla was significantly lower in the DSH group than the DSL group, but significantly higher in the DRH group compared to the DRL group. The density of alpha 1-adrenoceptors (as measured with [3H]-WB4101) in the hypothalamus was lower in the DSH group than the DSL group but greater in the DRH group than the DRL group. The results suggest that the sensitive and resistant lines can be distinguished by the density of alpha 1- adrenoceptors in the hypothalamus and medulla, respectively. The interactive effects of dietary NaCl and susceptibility to hypertension on adrenoceptors lend further support to the hypothesis that the genetic predisposition to hypertension is associated with a disruption in central adrenergic activity.

Myocardial cholinergic receptor sites and enzyme activity in the Dahl model of essential hypertension

The density of muscarinic receptor sites, choline acetyltransferase (ChAT), and acetylcholinesterase (AChE) activity in the myocardium of the Dahl salt-sensitive (DS) and salt-resistant (DR) rat was investigated. Both normotensive and hypertensive (as a result of 8.0% NaCl added to the diet) DS rats displayed a lower concentration of muscarinic receptors and less ChAT and AChE activity in myocardial tissue than normotensive DR rats. Lower receptor site density and enzyme activity in the myocardial of the DS line may reflect decreased vagal tone. If true, this may produce dificits in the ability to appropriately adjust heart rate (HR) in response to elevations in blood pressure (BP). Therefore, the present results may be viewed as exacerbational factors in the pathogenesis of hypertension in the DS line.

Remission of essential hypertension after renal transplantation

Six patients in whom "essential hypertension" led to nephrosclerosis and kidney failure received kidney transplants from normotensive donors. After an average follow-up of 4.5 years, all were normotensive and had evidence of reversal of hypertensive damage to the heart and retinal vessels. These six patients, all of whom were black, and six control subjects matched for age, sex, and race were admitted to the General Clinical Research Center for 11 days for observation of their blood pressure and their responses to salt deprivation and salt loading. Mean arterial pressure (+/- S.E.M.) among the patients who had previously had essential hypertension was similar to that of the normal controls (92 +/- 1.9 vs. 94 +/- 3.9; P not significant), and both groups had similar responses to salt deprivation and salt loading. Thus, essential hypertension in human beings is shown to be similar to the hypertension seen in spontaneously hypertensive rats in that both can be corrected by transplantation of a kidney from a normotensive donor. This observation supports the concept of the primary of the kidney in causing essential hypertension.

Cholinergic receptor site binding, choline acetyltransferase, and acetylcholinesterase activity in the forebrain and brainstem of the Dahl rat model of essential hypertension

Muscarinic and nicotinic receptor site binding and the activity of choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) in the forebrain and brainstem of Dahl salt-sensitive (DS) and salt-resistant (DR) rats was investigated. The DS line had a greater density of muscarinic sites in the cortex, hypothalamus, and medulla. Hypertensive DS rats had a greater density of sites than normotensive DS rats. ChAT activity was also higher in the cortex and hypothalamus of the DS line than the DR line. No significant differences were found in the activity of AChE or the concentration of nicotinic sites. These results suggest that the central muscarinic cholinergic system may participate in the pathogenesis of hypertension in the DS rat. The data indicate that central cholinergic activity is possibly greater in the DS than the DR rat and that this may help to explain the enhanced pressor response in the DS line after pharmacological activation of the central cholinergic system.

Sodium sensitivity and resistance in normotensive humans

To identify characteristics that may contribute to sodium susceptibility, we conducted, studies in normal subjects who are at risk for hypertension, namely, blacks, subjects older than 40 years of age and first-degree relatives of patients with essential hypertension. All three groups exhibited a decreased natriuretic capacity when compared with control subjects. Blacks and older subjects had consistently low renin values, while the plasma renin activity values of the relatives were greater than those in control subjects. Studies in twins showed that natriuretic capacity and several factors influencing sodium excretion are heritable. When blacks were subjected to extremely high sodium intake, a greater increase in blood pressure developed than in whites. These observations are consistent with an intrinsic renal abnormality in blacks and older subjects resulting in modest volume expansion. In the normotensive relatives of hypertensive patients, the renin system may be responsible for the decreased sodium excretory capacity. These alterations are possibly inherited.

(Na+,K+)-activated adenosinetriphosphatase and hypertension in DAHL salt- sensitive and -resistant rats

(Na+,K+)-ATPase activity was compared in Dahl salt-sensitive (S) and salt-resistant (R) rats. When S and R rats were maintained on 1% NaCl diet their blood pressures at 5 weeks of age were similar and their renal microsomal (Na+,K+)-ATPase activities were also similar. At 6 months of age, on 1% NaCl diet, S rats have markedly elevated blood pressure compared to R and renal microsomal (Na+,K+)-ATPase activity was suppressed in S compared to R. Feeding 8% NaCl diet for 5 weeks induced hypertension in young S rats but failed to alter renal or brain (Na+,K+)-ATPase activity. Heart (Na+,K+)- ATPase activity was elevated in S compared to R rats regardless of salt intake of blood pressure. It appears unlikely that mutations in the structural locus for the renal (Na+,K+)-ATPase molecule are involved in the strain specific differences in susceptibility to salt-induced hypertension since the physical-chemical properties of the enzyme from the two strains were found to be similar. Since renal (Na+,K+)-ATPase activities were unchanged by salt feeding and resultant blood pressure changes in young S rats, the suppressed renal (Na+,K+)-ATPase activity seen only in old S rats is probably a response to prolonged renal damage and not a response to "natriuretic factors." Elevated heart (Na+,K+)-ATPase in S-rat hearts is unexplained.

Psychobiology of experimental hypertension: evaluation of the Dahl rat lines

The Dahl salt-sensitive (DS) and salt-resistant (DR) rat lines were selectively bred to show opposite genetically determined blood pressure responses to excess sodium chloride ingestion. These animals have provided significant anatomical, physiological, and biochemical data concerning the pathological mechanisms of experimental hypertension. Research is also being conducted to determine the relevance of psychobiological and behavioral variables in these two lines. The rationale for the selection and maintenance of the Dahl model and the physiological, biochemical, and behavioral characteristics which distinguish DS and DR rats are presented. Although originally developed for the study of salt-induced hypertension, special attention is given to the application of this animal model in behavior genetic research, stressing its inherent advantages and limitations. The use of the Dahl model in psychobiological studies and the utility of the model for future behavioral, genetic, and psychophysiological research are also detailed.

Evidence for a circulating sodium transport inhibitor in essential hypertension

The active sodium transport of white cells and red cells obtained from patients with essential hypertension was impaired. Incubating white cells from normotensive subjects in serum obtained from patients with essential hypertension caused an impairment in sodium transport in the white cells of normotensive subjects similar to that found in the white cells of hypertensive patients. The impairment in sodium transport was due to a fall in the ouabain-sensitive component of the total sodium efflux rate constant. These results show that the serum of patients with essential hypertension contains a substance which influences sodium transport and that it has ouabain-like activity. They also suggest that it is this substance which causes the impairment in sodium transport in the leucocytes of patients with essential hypertension. These findings support the hypothesis that the rise in blood pressure in patients with essential hypertension is due to an increased concentration of a circulating sodium transport inhibitor which is continuously correcting a tendency for sodium retention by the kidney.

Pressure natriuresis in isolated kidneys from hypertension-prone and hypertension-resistant rats (Dahl rats)

Dahl described a strain of rats with genetically controlled propensities for hypertension. Chronic excess salt feeding increased blood pressure in sensitive (s) rats, whereas resistant rats (R) remain normotensive. We tested the pressure natriuretic function (urinary sodium excretion versus perfusion pressure) in isolated kidneys perfused with a cellular medium: in sodium-restricted normotensive sensitive (S0) and resistant (R0) animals; in sensitive rats receiving a high-salt diet for 3 weeks (S3): and in both S and R animals exposed to excess sodium for 7 weeks (R7 and S7). The aim of these studies was to determine if a preset alteration of the pressure natriuretic function might be present in S animals prior to the development of hypertension. Systolic blood pressure in S0, S3, and S7 animals were 123 +/- 4, 136 +/- 2, and 162 +/- 4 mm Hg, respectively, whereas that of R0 and R7 were 121 +/- 5 and 126 +/- 5 mm Hg. An increase of the perfusion pressure of isolated kidneys from 105 to 185 mm Hg in stepwise fashion resulted in a pressure natriuresis whose slope was similar in R0 and S0 animals. Of interest was that the pressure natriuretic function slope of kidneys from R0 (low sodium) and R7 (high sodium) rats was as predicted by the Guyton system analysis of normal blood pressure control Micropuncture of the proximal nephrons demonstrated that the origin of the natriuresis resulted from a site beyond the accessible proximal tubule. Results from S7 kidneys contrasted with all others in that the natriuretic response was depressed (P less than 0.01), which resulted from significantly lower filtration rates at higher perfusion pressures. We concluded (1) in normal R rats, the pressure natriuretic function is that predicted by the Guyton hypothesis, (2) Dahl S animals have no preset abnormality of this function until hypertension is present for some time, and (3) a depression of the pressure natriuretic function may aggravate hypertension in S rats once high blood pressure has persisted.