Some theories of hypertension: fact and fancy

The role of vascular steroid receptors in the control of vascular contractility and peripheral vascular resistance

Evidence is presented that glucocorticoids (GC) and mineralocorticoids (MC) control contractility of vascular smooth muscle (VSM). This control is effected through the in situ mechanism for the action of these steroids in the arterial and arteriolar wall. This action is mediated through GC and MC receptors in the VSM cell. Acting through these receptors, MC and GC increase transport capacities of different transmembrane transport systems for Na+ and/or Ca2+ through induction of synthesis of proteins constituting the transport systems. Colocalization of enzymes deactivating cortisol in VSM, with VSM receptors for GC and MC further strengthens the concept that the arterial network houses an in situ molecular mechanism for the control of VSM contractility, thus peripheral vascular resistance.

Cardiovascular, humoral, and renal effects of phenoxybenzamine in hypertension

We examined the effects of alpha adrenergic receptor blockade with phenoxybenzamine on various parameters related to blood pressure regulation in 10 normotensive and 12 essential hypertensive subjects. The responses were observed before and after phenoxybenzamine treatment during standardized maneuvers of volume expansion with saline infusion and volume contraction with a diuretic. Alpha adrenergic blockade produced a significantly greater (P less than 0.02) reduction in blood pressure in the hypertensive group than in the normotensive subjects. The baroreceptor response, evaluated by comparing the change in plasma norepinephrine concentration in relation to the change in blood pressure, was significantly reduced (P less than 0.05) in hypertensives compared to normal subjects. Plasma and urinary norepinephrine concentration, which were similar in the two groups, increased in both during phenoxybenzamine treatment. There was no significant change in the mean levels of plasma renin activity or plasma aldosterone concentration in either group after phenoxybenzamine treatment. However, the relationship between plasma renin activity and plasma aldosterone levels, as judged by linear regression analysis, was significantly altered (P less than 0.05) by phenoxybenzamine therapy in both groups. The latter may reflect an effect of phenoxybenzamine on the metabolism or secretion of aldosterone. These results, utilizing an alpha adrenergic antagonist, confirm the enhanced vascular reactivity and diminished baroreceptor function in essential hypertension; no evidence for an alpha adrenergic effect on plasma renin activity could be demonstrated in normotensive or hypertensive subjects.

Diabetes and arterial hypertension

The epidemiology, pathogenesis, significance and management of hypertension in diabetic subjects are discussed. In Type 1 diabetes the presence of diastolic hypertension is closely related to the presence of diabetic nephropathy, from the stage of persistent proteinuria onwards. There may also be some elevation of systolic pressure. The apparent increased prevalence of hypertension in Type 2 diabetes is largely explicable, directly or indirectly, by obesity but there may be an excess of systolic hypertension among elderly patients. Hypertension in the diabetic population is associated with an increased incidence of both microvascular and macrovascular complications, but whether the high blood pressure is causal is not clear. The possible roles of sodium and insulin, the renin-angiotensin system, catecholamines and physical factors are explored. All current antihypertensive agents have additional limitations and disadvantages when used in diabetic patients: diuretics and beta-blockers are probably the initial drugs of choice. Only in the case of diabetic nephropathy is there yet reasonable evidence of antihypertensive treatment reducing the rate of progression of the disease.

Studies on high affinity binding of mineralo- and glucocorticoids in rabbit aorta cytosol

High affinity, specific binding-sites to mineralocorticoids and glucocorticoids, with characteristics of steroid receptors, have been found in rabbit aorta cytosol. Binding parameters (dissociation constants and number of binding sites per mg of cytosol protein) were determined from Scatchard plots, after statistical treatment of the data with the aid of a computer program, for the following tritiated steroids: 11-desoxycorticosterone (DOC), aldosterone (Aldo), progesterone (Prog), corticosterone (BK), cortisol (FK) and dexamethasone (Dex). The specificity of binding was then examined by means of steroid competition studies. The results of these experiments indicate that three different types of high-affinity binding sites to adrenal steroids are present in aorta cytosol: Type A, with the highest affinity for DOC; Type B, with the highest affinity for FK; Type C, with the highest affinity for Dex. In accordance with the relative competitive potencies of various steroids for these binding sites, Type A is designated as the "arterial mineralocorticoid binder", clearly differing in its binding characteristics from the cytoplasmic mineralocorticoid binders in known target tissues to these steroids (e.g. the renal receptor), while Type C is designated as the "arterial glucocorticoid binder", closely resembling the classical glucocorticoid receptor in known target tissues to glucocorticoids. Type B exhibited some of the binding characteristics of transcortin and may represent a modified, intracellular transcortin. While Types B and C are present also in the cytosol of inferior vena cava. Type A was only in the aorta. The role of these binders is not known at present. Arguments are presented in favor of a hypothesis that the Type A (mineralocorticoid) binder represents an arterial wall; and that, under certain conditions, this action leads to an increased contractility of arterial and arteriolar smooth muscles, increased peripheral resistance and hypertension.

Evidence for the presence in arterial walls of intracellular-molecular mechanism for action of mineralocorticoids

Data from clinical and experimental studies indicate that mechanism(s) for action of mineralocorticoids, other than renal, must be involved in the overall effect of mineralocorticoids on circulation--increased peripheral resistance and hypertension. We have postulated existence of such a mechanism in the arterial wall and have looked for the evidence for its presence. We have found high affinity, specific binders for mineralocorticoids, and glucocorticoids, with characteristics of steroid receptors, in the cytosol of rabbit aorta and femoral and carotid arteries. These binders possess physicochemical properties of steroid receptors and, moreover, they translocate to cell nuclei (as steroid-receptor complexes) and bind to relatively specific "acceptor-sites" on nuclear chromatin. This provides evidence for the existence of an intracellular-molecular mechanism for a direct in situ action of mineralocorticoids, and also glucocorticoids, in the arterial wall. We postulate that the demonstrated previously effect of mineralocorticoids on arterial smooth muscle cell-membrane permeability to electrolytes, leading presumably to increased peripheral resistance and hypertension, is elicited through the receptor-mediated mechanism for action of mineralocorticoids in the arterial wall.