Beta-adrenoceptor responsiveness in hypertension: effects of dietary NaCl intake

Altered beta-2 adrenergic receptor gene expression in human clinical hypertension

OBJECTIVES

The beta-2 adrenergic receptor is involved in mediating vasodilatation via neurohumoral and sympathetic nervous system pathways. Alterations in beta-2 adrenergic receptor gene expression (mRNA transcription) may contribute to the hypertensive phenotype. Human gene expression in clinical phenotypes remains largely unexplored due to ethical constraints involved in obtaining human tissue. We devised a method to obtain normally discarded internal mammary artery tissue from coronary artery bypass graft patients. We then investigated differences in hypertensive and normotensive participants' beta-2 adrenergic receptor gene expression in this tissue.

METHODS

We collected arterial tissue samples from 46 coronary artery bypass patients in a surgical setting. Using 41 of the samples, we performed TaqMan real-time polymerase chain reaction (RT-PCR) and used the delta delta cycle threshold (DeltaDeltaCt) relative quantitation method for determination of fold-differences in gene expression between normotensive and hypertensive participants. The beta-2 adrenergic receptor target was normalized to glyceraldehyde-phosphate dehydrogenase.

RESULTS

Participants with hypertension had significantly less-expressed beta-2 adrenoceptor gene (2.76-fold, p<.05) compared to normotensive participants. After Bonferroni correction, gene expression did not differ by race, gender, type/dose of beta-blocker prescribed, positive family history of hypertension, or diagnosis of diabetes mellitus type 2.

CONCLUSIONS

These data support the possibility of a molecular basis for impaired adrenoceptor-mediated vascular tone in hypertension. Modification and extension of this research is required.

GENETIC VARIATION IN THE β(2)-ADRENERGIC RECEPTOR: IMPACT ON INTERMEDIATE CARDIOVASCULAR PHENOTYPES

Genetic variation in drug targets (e.g. receptors) can have pronounced effects on clinical responses to endogenous and exogenous agonists. Polymorphisms in the gene encoding the β(2)-adrenergic receptor (β(2)-AR) have been associated with altered expression, down-regulation, and altered cell signaling in vitro. Because β(2)-ARs play a crucial role in the regulation of the cardiovascular system, the functional importance of genetic variation in the β(2)-AR on cardiovascular responses to physiological or pharmacological stimuli has gained widespread attention. The objective of this review is to characterize these intermediate cardiovascular phenotypes and their influence on cardiovascular disease and adrenergic drug responses.Two common single nucleotide polymorphisms, encoded at codon 46 (Gly(16)Arg) and 79 (Gln(27)Glu) of the β(2)-AR gene, have been studied intensively. They have been shown to be associated with altered vasodilator responses to regional and systemic administration of β(2)-agonists, altered cardiovascular responses to sympathoexcitatory maneuvers, and altered myocardial function. Importantly, these intermediate physiological patterns may influence the development of and the outcomes associated with hypertension and other cardiovascular diseases. As recently reported, β(2)-AR gene variation can risk-stratify patients receiving β-blocker therapy and may predict β-blocker efficacy in patients post acute coronary syndrome or in patients with heart failure.Further studies will advance our understanding of the link between β(2)-AR genotypes, intermediate cardiovascular phenotypes, and clinical phenotypes. In the long term, reassessment of the benefits of β-blocker-therapy within genotype groups should be carried out with the ultimate goal to design the optimal therapeutic regimen for the individual patient.

Are patients chronically treated with beta 1-adrenoceptor antagonists in fact beta-blocked?

OBJECTIVE

To determine cardiovascular beta-receptor function in patients with ischemic heart disease chronically treated with beta 1-adrenoceptor antagonists.

DESIGN

Prospective, single-blind, nonrandomized clinical trial.

SETTING

University Department of Cardiothoracic Anesthesia.

PARTICIPANTS

Forty middle-age men scheduled for primary elective coronary artery bypass surgery. Twenty patients were treated with beta 1-antagonists.

INTERVENTIONS

After induction of anesthesia, increasing intravenous bolus doses of isoproterenol were administered in order to increase heart rate more than 25 BPM. From this dose-response curve, the isoproterenol dose needed to increase heart rate by exactly 25 BPM was calculated.

MEASUREMENTS AND MAIN RESULTS

Baseline cardiovascular variables and the pharmacodynamic responses to isoproterenol were monitored with catheters in the radial and the pulmonary artery (thermodilution catheter). Heart rate was continuously calculated from the electrocardiogram. The hemodynamic status after induction of a standardized fentanyl anesthesia and the chronotropic and inotropic responses to the isoproterenol titration procedure were identical in the 20 beta 1-blocked patients and in the 20 control patients. The median dose of isoproterenol needed to increase heart rate 25 BPM was 10.9 micrograms in the beta-blocked patients and 9.4 micrograms in the control group.

CONCLUSION

Patients chronically treated with beta 1-antagonists compensate for the perturbation to such a degree that cardiovascular beta-receptor function is in fact normal.

Expression of beta-adrenoceptors on circulating mononuclear cells in hypertensives and normotensives before and after reduction of central sympathetic outflow by clonidine

We have studied beta-adrenoceptor number and affinity on peripheral blood mononuclear cells (PBMCs) in normotensives (NT) and hypertensives (HT), before and after intravenous administration of clonidine, an alpha 2-adrenoceptor agonist which lowers blood pressure predominantly by reducing central nervous system sympathetic outflow. After clonidine, there was a decrease in blood pressure and plasma noradrenaline (NA) and adrenaline (Ad) levels, with an increase in growth hormone (GH) levels, in both NT and HT. There was no difference in basal beta-adrenoceptor densities on PBMCs between NT and HT. After clonidine at 30 and 60 min, there was an increase in beta-adrenoceptor density associated with a low affinity in NT. In HT, no changes were observed. The increased beta-adrenoceptor densities on PBMCs in NT after clonidine, returned to baseline values after 2 h. Short term up-regulation of beta-adrenoceptors on PBMCs in NT after clonidine is accompanied by a fall in blood pressure (BP) and plasma levels of catecholamines. The changes may represent a compensatory mechanism reflecting a rapid externalization-activation of adrenoceptors residing on the internal surface of the membranes with a change of the coupling ability between the receptor and the catalytic component. In HT, although the haemodynamic and neurohormonal response to clonidine was similar to NT, short term upregulation of receptors did not occur. The lack of such response may mirror a form of regulatory dysfunction of beta-adrenoceptors in HT.