Agents which block the action of the renin-angiotensin system

The role of IL-6 in the physiologic versus hypertensive blood pressure actions of angiotensin II

Angiotensin II (AngII) is a critical physiologic regulator of volume homeostasis and mean arterial pressure (MAP), yet it also is known to induce immune mechanisms that contribute to hypertension. This study determined the role of interleukin-6 (IL-6) in the physiologic effect of AngII to maintain normal MAP during low-salt (LS) intake, and whether hypertension induced by plasma AngII concentrations measured during LS diet required IL-6. IL-6 knockout (KO) and wild-type (WT) mice were placed on LS diet for 7 days, and MAP was measured 19 h/day with telemetry. MAP was not affected by LS in either group, averaging 101 ± 4 and 100 ± 4 mmHg in WT and KO mice, respectively, over the last 3 days. Seven days of ACEI decreased MAP ∼25 mmHg in both groups. In other KO and WT mice, AngII was infused at 200 ng/kg per minute to approximate plasma AngII levels during LS. Surgical reduction of kidney mass and high-salt diet were used to amplify the blood pressure effect. The increase in MAP after 7 days was not different, averaging 20 ± 5 and 22 ± 6 mmHg in WT and KO mice, respectively. Janus Kinase 2 (JAK2)/signal transducer of activated transcription (STAT3) phosphorylation were not affected by LS, but were increased by AngII infusion at 200 and 800 ng/kg per minute. These data suggest that physiologic levels of AngII do not activate or require IL-6 to affect blood pressure significantly, whether AngII is maintaining blood pressure on LS diet or causing blood pressure to increase. JAK2/STAT3 activation, however, is tightly associated with AngII hypertension, even when caused by physiologic levels of AngII.

Partial correction of hypertension by angiotensin II blockade in a patient with phaeochromocytoma

This case report describes a patient with malignant hypertension and phaeochromocytoma in whom blockade of angiotensin II receptors by the competitive antagonist 1-sar-8-ala-angiotensin II (Saralasin) resulted in a partial correction of the elevated BP. Plasma renin activity was high and rose further during the blockade. Competitive inhibition of angiotensin II by Saralasin does not abolish the pressor effect of catecholamines. It was therefore interesting to observe that in this patient with phaeochromocytoma, independently, both alpha-adrenergic receptor blockade and angiotensin II receptor blockade were effective in lowering BP.

Effect of contraceptive steroid and enalapril treatment of systolic blood pressure and plasma renin-angiotensin in the rat

Previous work has demonstrated contraceptive steroid-induced hypertension in rats. Here, we examined the relationship between steroid-induced hypertension and components of the renin-angiotensin system. Female Sprague-Dawley rats were injected s.c. with 0.2 micrograms ethynyloestradiol, 2.0 micrograms levonorgestrel, a combination of both or vehicle, six days per week. A second group of rats received 2.0 micrograms enalapril maleate, enalapril plus ethynyloestradiol or levonorgestrel, or vehicle. Systolic blood pressure increased with both ethynyloestradiol. (6 weeks, +17 mmHg; 12 weeks, +32 mmHg) and levonorgestrel (6 weeks, +24 mmHg) treatment. This effect of levonorgestrel was attenuated by co-administration of enalapril, which also reversed the hypertension seen with ethynyloestradiol. Ethynyloestradiol, but not levonorgestrel treatment caused a significant increase in plasma renin concentration, plasma renin activity, and plasma angiotensin II at both 6 and 12 weeks. Plasma renin substrate was increased by ethynyloestradiol at 3, 6 and 12 weeks, prior to the observed increase in systolic blood pressure. Combined steroid treatment had less pronounced effects. Enalapril alone or in combination with ethynyloestradiol decreased plasma renin concentration, activity and angiotensin II, and in combination with levonorgestrel decreased plasma renin concentration, substrate and activity (6 weeks only) but not angiotensin II. The data indicate a positive relationship between hypertension and the renin-angiotensin system with ethynyloestradiol, but not levonorgestrel treatment in rats.

Turnover of central biogenic amines in two-kidney, one-clip renal hypertensive rats

Turnover rates, as estimated from the accumulation of the intermediates dihydroxyphenylalanine (DOPA) and 5-hydroxytryptophan (5-HTP) following decarboxylase inhibition, were used to investigate the relationship between central catecholaminergic and serotonergic neurons and the development of hypertension in 2-kidney, 1-clip renal hypertensive rats. Results indicated that at one week following clipping, DOPA accumulation was increased in the midbrain-pons. At 5 weeks no changes were observed. At 20 weeks a lower accumulation of both DOPA and 5-HTP was observed in the posterior hypothalamus while in the medulla oblongata DOPA accumulation was lower and in the midbrain-pons 5-HTP accumulation was reduced.

Identification of the angiotensin II receptor in rat mesenteric artery

Specific binding sites of high affinity and low capacity for 125I-angiotensin II have been identified in a membrane fraction derived from arterial arcades of the rat mesentery. Heterogeneity of binding sites and extensive tracer degradation necessitated the use of nonlinear regression methods for the analysis of radioligand binding data. Forward and reverse rate constants for the high affinity sites obtained by three experimental approaches were in good agreement and gave a dissociation equilibrium constant (Kd) of 19-74 pM (95% confidence interval). Affinities for a number of angiotensin-related peptides calculated from competitive binding curves were in the order 125I-angiotensin II = angiotensin II greater than angiotensin III greater than [Sar1,Ile8]angiotensin II greater than [Sar1,Gly8]angiotensin II. Angiotensin I and biochemically unrelated peptides had virtually no effect on binding of tracer angiotensin II. The divalent cations Mn2+, Mg2+ and Ca2+ stimulated 125I-angiotensin II binding at concentrations of 2-10 mM, as did Na+ at 50-100 mM. In the presence of Na+ or Li+, K+ had a biphasic effect. The chelating agents EDTA and EGTA were inhibitory, as were the thiol reagents dithiothreitol and cysteine. This study defined angiotensin II binding sites in a vascular target tissue of sufficiently high affinity to interact rapidly with plasma angiotensin II at physiological concentrations.

Different antagonist potency of saralasin in acute and chronic angiotensin-dependent hypertension

We investigated the antagonistic properties of saralasin in acute and chronic angiotension II (ANG II)-dependent hypertension. Two models of experimental hypertension were studied: (a) Rats acutely infused i.v. with ANG II to raise the blood pressure (BP) by about 35 mmHg. (b) One-clip, two-kidney renal hypertensive rats. In both experimental models increasing doses of saralasin were infused i.v., and three parameters were evaluated at each dose level: (1) fall of BP, (2) plasma concentration of saralasin, and (3) plasma concentration of ANG II. It was found that saralasin led to a more pronounced fall of BP in malignant than in benign renal hypertension. To reduce BP by about 20 mmHg, saralasin plasma concentrations had to exceed those of ANG II about 2000-fold in renal hypertension and about 7-fold in rats infused with ANG II. It is concluded that saralasin antagonises ANG II more effectively in acute than in chronic hypertension.

Angiotensin inhibits action of vagus nerve at the heart

The effects of angiotensin II and angiotensin III (Des-Asp angiotensin II) on cardiac vagal nerve endings were studied in intact dogs and in isolated guinea-pig atria. Decreases in heart rate evoked by electrical stimulation of the peripheral end of the cut vagus were attenuated in the presence of angiotensin II and angiotensin III.

Decrease in peripheral sympathetic nervous system activity following renal denervation or unclipping in the one-kidney one-clip Goldblatt hypertensive rat

Increased sympathetic nervous system activity has been demonstrated in established one-kidney one-clip hypertension in the rat. We have found that renal denervation in this model results in an attenuation of hypertension, unassociated with alterations in sodium or water balance or renin activity. To determine whether the depressor effect of renal denervation is associated with changes in peripheral sympathetic nervous system activity, sham operation (n = 12), renal denervation (n = 13), or unclipping (n = 13) was carried out 2 wk after the onset of one-kidney one-clip hypertension. Normotensive unine-phrectomized age- and sex-matched rats were used as controls (n = 14). Renal denervation resulted in a significant decrease in systolic blood pressure (201+/-7 to 151+/-6 mm Hg), while unclipping lowered systolic blood pressure to normotensive levels (130+/-6 mm Hg). 8 d after operation plasma norepinephrine and mean arterial pressure before and after ganglionic blockade with 30 mg/kg hexamethonium bromide were measured in conscious, unrestrained, resting animals, as indices of peripheral sympathetic nervous system activity. Plasma norepinephrine was significantly higher in hypertensive sham-operated rats (422+/-42 pg/ml) compared with normotensive controls (282+/-25 pg/ml) (P < 0.01). Both renal denervation and unclipping restored plasma norepinephrine to normal levels (273+/-22 and 294+/-24 pg/ml, respectively). Ganglionic blockade in hypertensive sham-operated animals resulted in a significantly greater decrease in mean arterial pressure than occurred in renal denervated, unclipped, or control rats. The data suggest that the depressor effect of renal denervation or unclipping in the one-kidney one-clip hypertensive rat is associated with a decrease in peripheral sympathetic nervous system activity.

Effect of three angiotensin II antagonists, [Sar1, Thr8]-, [Sar1, Ile8]- and [Sar1, Ala8]angiotensin II on blood pressure and endocrine factors in normal subjects

The biological effects of 1-Sarcosine, 8-Threonine angiotensin II ([Sar1, Thr8]ANG II) on blood pressure, plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were investigated in six normal subjects on an unrestricted diet, and compared with those of 1-Sarcosine, 8-Isoleucine ANG II ([Sar1, Ile8]ANG II) and 1-Sarcosine, 8-Alanine ANG II ([Sar1, Ala8]ANG II). All three ANG II analogues (AIIA) showed agonistic pressor activity, that of [Sar1, Ile8]ANG II being greater than that of [Sar1, Thr8]ANG II or [Sar1, Ala8]ANG II. The antagonistic effect of [Sar1, Thr8]ANG II on blood pressure was less than [Sar1, I1e8]ANG II or [Sar1, Ala8]ANG II. Both [Sar1, Ile8]ANG II and [Sar1, Ala8]ANG II increased PAC and blocked the steroidogenic action of ANG II, while [Sar1, Thr8]ANG II showed little effect on PAC. All three AIIA caused similar suppression of PRA and showed no inhibitory effect on the decrease in PRA produced by ANG II. These results indicate that [Sar1, Thr8]ANG II is an AIIA with weak agonistic pressor action and that it has vascular selective properties. It is also suggested that ANG II receptors in a variety of target organs are heterogeneous.

Effects of two angiotensin II analogues on blood pressure, plasma aldosterone concentration, plasma renin activity and creatinine clearance in normal subjects on different sodium intakes

Two angiotensin II analogues (AIIA), 1-sarcosine, 8-isoleucine angiotensin II ([Sar, Ile]-AII) and 1-sarcosine, 8-alanine angiotensin II ([Sar, Ala]-AII), were infused in six normal volunteers on high, regular and low sodium diets. The agonist and antagonist activities of these AIIA on blood pressure (BP), plasma aldosterone concentration (PAC), creatinine clearance and plasma renin activity were examined. Both AIIA had agonistic pressor activities in subjects on high and regular sodium diets, [Sar, Ile]-AII being more potent than [Sar, Ala]-AII. Both AIIA caused similar elevation of PAC in subjects on high and regular sodium diets, and an equally fall in PAC in subjects on a low sodium diet. Both AIIA strongly antagonized the rise in BP, the increase in PAC and the reduction of Ccr induced by AII administration in subjects on all three sodium diets. The results indicate that both AIIA can be used to examine the activity of the renin-angiotensin system in patients with hypertension, and they also suggest that AII interaction with its receptors differs in different target tissues.

Neurotensin-induced contractions in venous smooth muscle

Synthetic neurotensin was shown to be a powerful contractant of the isolated rat portal vein. Concentration-dependent increases in basal tension and frequency of spontaneous contractions were obtained in response to single dose (10-1000 nM, final bath concentrations). The responses reached maxima within 2 min and differed in this respect from comparable responses to angiotensin II, substance P and bradykinin, which were maximal after 2-4 min. The "apparent affinity" for neurotensin (pD2 = 7.5 +/- 0.3, S.D., n = 10) was about 10 times less than for angiotensin II while higher than for both the other peptides and for norepinephrine. The "intrinsic activity" was 0.75 (+/- 0.13, S.D., n = 6) relative to angiotensin II during the first 2 min of the response. A pronounced degree of tachyphylaxis was observed; repetition of the neurotensin dose at the lower range of concentrations (1-10 nM) within 2-4 min was completely ineffective. The results suggest that there is a specific neurotensin receptor in the tissue and that neurotensin-induced contractions may play a part in redistributing the blood flow in the gastrointestinal region following release of this peptide from the ileum into the portal circulation.

Plasma renin activity in coarctation of the aorta before and after surgical correction

In 37 patients with coarctation of the aorta, arterial blood pressure and ambulant plasma renin activity (PRA) were determined before and, in 15 patients, after surgical correction. The systolic blood pressure was raised in all the cases and the diastolic pressure was raised in 30 patients. Ambulant PRA was increased in 11 patients when compared with normal subjects of similar age. Twelve of the 15 operated patients had a significant decrease of systolic pressure after operation. Eight had raised PRA, and in 7 of these PRA fell to normal after operation and the blood pressure also fell; in 1 patient the decrease of PRA was unaccompanied by a fall in blood pressure. Though there was no significant correlation between the changes in blood pressure and PRA after operation it seems possible from our results that the renin-angiotensin system may be activated and contribute to the raised arterial pressure which occurs in patients with aortic coarctation.

Hypotension induced by inhibition of angiotensin-converting enzyme in pentobarbital-anesthetized dogs

The mechanism of the hypotensive response produced by inhibition of the angiotensin converting enzyme was studied in pentobarbital anesthetized dogs. A recently developed potent inhibitor of the converting enzyme, SQ 14,225 (D-3-mercapto-2-methyl propanoyl-L-proline), administered i.v. to intact dogs resulted in a rapid marked decrease in blood pressure. In nephrectomized dogs, SQ 14,225 retained significant hypotensive activity, although the absolute magnitude of the decreases in blood pressure were less than had been observed in dogs with intact kidneys. SQ 14,225 also lowered blood pressure when administered to intact dogs in which angiotensin II receptors had been blocked with the receptor antagonist Sar1,Ala8-angiotensin II. This apparent ability of SQ 14,225 to decrease blood pressure in the absence of a functional renin angiotensin system was shared by a structurally dissimilar, nonapeptide, angiotensin converting enzyme inhibitor, SQ 20,881 (Glu-Trp-Pro-Arg-Pro-Gln-Ile-Pro-Pro). SQ 20,881 also produced significant decreases in blood pressure in nephrectomized dogs. These findings indicate that the angiotensin converting enzyme inhibitors, SQ 14,225 and SQ 20,881 may lower blood pressure in anesthetized normotensive dogs via a mechanism unrelated to either the renin angiotensin system or the renal kinin system.

Influence of angiotensin antagonists on renal vascular resistance and prostaglandin E release

Blood pressure (BP), renal arterial pressure and renal blood flow (RBF) were measured and blood samples were removed for determination of prostaglandin E (PGE) content in pentobarbital anesthetized dogs. Analysis of PGE with prior column separation was by radioimmunoassay utilizing a PGF antiserum and PGE specific anti-serum. The angiotensin antagonists 1-Sar-8-Ala-angiotensin II (saralasin) and 1-Sar-Ileu-angiotensin II (1-S-8-I A) were infused intraarterially to the kidney achieving concentrations of 20 and 50-60 ng/ml and 10 and 20 ng/ml, respectively before and during partial occlusion of the renal artery (RAO). 1-S-8-I A, 20 ng/ml, caused a small increase in renal vascular resistance (RVR) before RAO, but saralasin exerted no effect prior to RAO. Arterial and renal venous PGE levels were not affected by the antagonists. RAO caused a decrease in RVR and gradual increase in BP which ranged from 29-38% and 12-15 mmHg, respectively at the 20 min interval. The concentration of PGE in renal venous blood was found to be increased and the AV difference was significant when measurements were made using PGF antiserum, but no change was detectable when using PGE antiserum. The infusion of saralasin, but not 1-S-8-I A in the above concentrations caused a significant decrease in RVR during RAO; however, no changes in PGE levels were obtained with either agent. These results indicate that 1-S-8-I A has a more potent agonistic renal vasoconstrictor effect than saralasin as found before RAO, and saralasin exerts a renal vasodilator action only during RAO, which is due to angiotensin antagonism and not to PGE release.

Action of the competitive angiotensin II antagonist saralasin during the initial phase of glycerol-induced acute renal failure of the rat

The effects of the competitive angiotensin II antagonist saralasin (1-sarcosine-8-alanine-5-isoleucine-angiotensin II) on renal function in healthy rats and in rats with myohemoglobinuric acute renal failure were studied. Acute renal failure was induced by an intramuscular injection of 50% glycerol (10 ml.kg-1). Functional impairment of the glycerol treated animals consisted in a decrease of renal blood flow (electromagnetic flowmeter) and GFR and in an increase of urine volume and arterial blood pressure. In healthy rats saralasin (6 microgram.kg-1.min-1 i.v.) had no renal effects by itself but antagonized the angiotensin II (200 ng.kg-1.min i.v.) induced fall of renal blood flow and GFR and the increase of arterial blood pressure. Given to glycerol treated animals saralasin did not induce any change of arterial blood pressure, renal blood flow, GFR or the urinary excretion of fluid and sodium.

Effects of the nonapeptide SQ 20.881 on the blood pressure of conscious normotensive and chronic hypertensive mice

Prevention of conversion of angiotensin I to angiotensin II by means of a converting enzyme inhibitor, the nonapeptide SQ 20.881, in chronic hypertensive mice was followed by a drop in blood pressure in all mice independent of the ethiology of hypertension; in conscious normotensive mice was observed a significant decrease in blood pressure, which, however, was less than that observed in the hypertensive mice.

The effect of indomethacin, 6-hydroxydopamine, saralasin, and hemorrhage on renal hemodynamics

This report describes the response of the renal circulation to prolonged hemorrhagic hypotension and reinfusion of blood, and to the effect of a variety of drugs (saralasin, indomethacin, and 6-hydroxydopamine, 6-OH-DA). Plastic microspheres were used to measure blood flow perfusing the entire kidney and also the outer cortex, inner cortex, and medulla of the kidney. Cardiac output was determined with a Doppler flow probe, and total and regional flows were calculated. Redistribution of blood flow from outer cortex to inner cortex and medulla occurred during hemorrhage and after administration of saralasin and 6-hydroxy-dopamine, while indomethacin did not alter intrarenal flow distribution. Total renal flow increased after reinfusion of blood and saralasin, but decreased after indomethacin. It did not change after 6-hydroxydopamine. The results demonstrate that changes in total and intrarenal flow occur independently and are probably due to different mechanisms.

Vascular angiotensin receptors and their role in blood pressure control

The renin angiotensin system has an important role in regulating arterial blood pressure in homeostasis and disease. A reciprocal relationship exists between sodium balance and the circulating levels of renin and angiotensin II. The vascular responsiveness to angiotensin II, the major vasconstrictor component of the renal pressor system, can be impaired by numerous factors including sodium depletion or a reduction in effective plasma volume. In situations in which the renin-angiotensin system is activated, a negative relationship between the angiotensin II pressor response and the circulating angiotensin II level is observed. This effect seems to involve a change of the angiotensin II receptor interaction in the vascular smooth muscle. The prevention of angiotensin II generation by the inhibition of converting enzyme causes an immediate increase in the pressor response to angiotensin; after bilateral nephrectomy, it takes much longer to develop. In addition, the depressor response to angiotensin antagnoists and converting enzyme inhibitor is preserved after bilateral nephrectomy for much longer periods than can be accounted for by the disappearance of circulating renin. These observations support the view that the decrease in vascular response to angiotensin II during sodium deprivation or when body fluid volumes are reduced is the result of prior occupancy of the receptor sites by endogenous hormone generated both in the plasma and locally within blood vessel walls. Therefore, a change in the number or affinity of receptors consequent to a change in sodium balance or as a modulating function of the renin-angiotensin system need not be postulated to explain changes in angiotensin vascular responsiveness.

Control of renin release: a review of experimental evidence and clinical implications

Present knowledge of the mechanisms regulating release of renin is reviewed with particular emphasis on neural factors. Evidence is given for a direct effect of renal innervation on beta adrenergic receptors in juxtaglomerular cells, and for the involvement of reflex release of renin in conditions such as tilting and acute salt depletion. Participation of neural and nonneural mechanisms of control is also shown to occur in other conditions, such as aortic constriction and hemorrhage. The view is held that neural sympathetic factors might explain some of the renin disturbances found in essential hypertension. First, in patients with high renin hypertension part of the hypertension is renin-dependent, and these pressor levels of renin seem to be neurally induced since they can commonly be suppressed by beta adrenoreceptor blocking agents. Second, the hypothesis is presented that patients with low renin hypertension, at least those who have no volume disturbance, have a blunted sympathetic control of renin release. Therefore a sufficiently precise test of sympathetic activity, and possibly of body fluid volumes, should be associated with renin profiles for a better understanding of the pathophysiology of arterial hypertension and as a better guide to therapeutic management. Indeed, most of the available antihypertensive drugs act on sympathetic activity, body fluid volume or renin, and this multifaceted profile would provide more rational guidelines for treatment.

Hypertension in terminal renal failure

Inverse interrelations between plasma renin activity and exchangeable sodium or blood volume were found in both normotensive (N = 23) and hypertensive (N =29) hemodialysis patients (r= 0.47; P less than 0.005); however, mean plasma renin for any given sodium/volume state was at least two-fold higher in hypertensive than in normotensive hemodialysis patients or normal subjects (N =31). In the hemodialysis patients, blood pressure correlated weakly but significantly with the products of circulating renin and exchangeable sodium (r=0.37; P less than 0.005) or blood volume (r = 0.29; P less than 0.05). Multiple regression analysis including duration of previous hypertension as the second independent variable increased these correlation coefficients to 0.44 and 0.42, respectively. This suggests that hypertension in endstage kidney disease is often associated with resetting of the body sodium/fluid=renin feedback mechanism. Inappropriately increased plasma renine activity relative to the body sodium/volume state as well as high blood pressure-induced vascular changes may play important complementary roles, but it appears evident that additional mechanisms are also operative in maintaining end-stage renal hypertension.

In vivo effects of angiotensin antagonists on plasma aldosterone in the dog

The effects of infusions of equimolar doses of Sar1-Ile8-angiotensin II and of Sar1-Ala8-angiotensin II on plasma aldosterone, plasma renin activity and arterial blood pressure were compared in normal dogs. Plasma aldosterone increased significantly after Sar1-Ile8-angiotensin II whereas it was unaffected by Sar1-Ala8-angiotensin II. Changes in blood pressure and renin activity were small without marked differences between both groups of animals. The experiments demonstrate a clear steroidogenic potency of Sar1-Ile8-angiotensin II. Therefore, Sar1-Ala8-angiotensin II should be preferred as antagonist of the action of angiotensin II in the adrenal gland.

Time course of changes in plasma renin after blockade of the renin-system. Studies of conscious and anaesthetized, normal, adrenalectomized and spontaneously hypertensive rats

Inhibition of the angiotensin I converting enzyme with SQ 20.881 results in a 2 to 35 fold increase in plasma renin concentration in normal rats and in spontaneously hypertensive rats. The effect is transient, lasting for 1 to 3 hours even in the presence of prolonged blockade. The relative increase is independent of the pretreatment plasma renin concentration. The blood pressure is unchanged in conscious rats in which the effect of SQ 20.881 on plasma renin is believed to be due to a blockade of the negative feedback of angiotensin II on renin release. In anaesthetized rats, SQ 20.88) has an additional hypotensive effect which augments the increase in plasma renin. Saralasin is without effect on blood pressure and plasma renin in conscious normal rats and in spontaneously hypertensive rats, while it causes a transient 3 to 27 fold increase in plasma renin concentration in anaesthetized rats. It is suggested that this increase is hardly due to an interception of the feedback, but to the concomitant fall in blood pressure, as a similar hypotension and increase in plasma renin is produced by dihydralazine. It is furthermore found that Saralasin blocks renin release induced by SQ 20.881. This demonstrates that Saralasin is bound to the receptors in the juxtaglomerular cells and has slight, agonistic properties there. Both in conscious rats and in anaesthetized adrenalectomized rats substituted with DOCA and salt, SQ 20.881 as well Saralasin causes transient increases in plasma renin concentration. If such rats are only substituted with salt and not with DOCA, the effects of both blockers are in the form of severe hypotension and a permanent elevation of plasma renin.