ACTH dependent hypertension

The role of the parathyroid glands in adrenocorticotrophin-induced hypertension in the rat

The aim of this study was to determine whether parathyroidectomy (PTx) would modify hypertension secondary to adrenocorticotrophin (ACTH) administration. Male Sprague Dawley (SD) rats were randomly assigned to one of five groups; (i) sham (saline) treatment (NaCl 0.9% s/c 0.5 ml/kg/day), (ii) ACTH treatment (Synacthen Depot 0.5 mg/kg/day), (iii) saline/PTx/1% CaCl2 in water, (iv) ACTH/PTx/1% CaCl2 in water and (v) ACTH/1% CaCl2 in water. Tail cuff systolic blood pressure (SBP) and metabolic parameters were measured on alternate days for 4 control (C) and 11 treatment days (T0-T10). There was no change in SBP in the sham and saline/PTx/CaCl2 groups over T0-10. SBP increased in the ACTH treated groups. PTx did not modify ACTH-induced increases in SBP or metabolic effects. These results do not support a role for the parathyroids in the genesis of ACTH-induced hypertension in the rat.

Melanocortins and cardiovascular regulation

The melanocortins form a family of pro-opiomelanocortin-derived peptides that have the melanocyte-stimulating hormone (MSH) core sequence, His-Phe-Arg-Trp, in common. Melanocortins have been described as having a variety of cardiovascular effects. We review here what is known about the sites and mechanisms of action of the melanocortins with respect to their effects on cardiovascular function, with special attention to the effects of the gamma-melanocyte-stimulating hormones (gamma-MSHs). This is done in the context of present knowledge about agonist selectivity and localisation of the five melanocortin receptor subtypes cloned so far. gamma2-MSH, its des-Gly12 analog (= gamma1-MSH) and Lys-gamma2-MSH are 5-10 times more potent than adrenocorticotropic hormone-(4-10)(ACTH-(4-10)) to induce a pressor and tachycardiac effect following intravenous administration. The Arg-Phe sequence near the C-terminal seems to be important for full in vivo intrinsic activity. Related peptides with a C-terminal extension with (gamma3-MSH) or without the Arg-Phe sequence (alpha-MSH, as well as the potent alpha-MSH analog, [Nle4,D-Phe7]alpha-MSH), are, however, devoid of these effects. In contrast, ACTH-(1-24) has a depressor effect combined with a tachycardiac effect, effects which are not dependent on the presence of the adrenals. Although the melanocortin MC3 receptor is the only melanocortin receptor subtype for which gamma2-MSH is selective, in vivo and in vitro structure-activity data indicate that it is not via this receptor that this peptide and related peptides exert either their pressor and tachycardiac effects or their extra- and intracranial blood flow increasing effect. We review evidence that the pressor and tachycardiac effects of the gamma-MSHs are due to an increase of sympathetic outflow to the vasculature and the heart, secondary to activation of centrally located receptors. These receptors are most likely localised in the anteroventral third ventricle (AV3V) region, a brain region situated outside the blood-brain barrier, and to which circulating peptides have access. These receptors might be melanocortin receptors of a subtype yet to be identified. Alternatively, they might be related to other receptors for which peptides with a C-terminal Arg-Phe sequence have affinity, such as the neuropeptide FF receptor and the recently discovered FMRFamide receptor. Melanocortin MC4 receptors and still unidentified receptors are part of the circuitry in the medulla oblongata which is involved in the depressor and bradycardiac effect of the melanocortins, probably via interference with autonomic outflow. Regarding the effects of the gamma-MSHs on cortical cerebral blood flow, it is not yet clear whether they involve activation of the sympathetic nervous system or activation of melanocortin receptors located on the cerebral vasculature. The depressor effect observed following intravenous administration of ACTH-(1-24) is thought to be due to activation of melanocortin MC2 receptors whose location may be within the peripheral vasculature. Melanocortins have been observed to improve cardiovascular function and survival time in experimental hemorrhagic shock in various species. Though ACTH-(1-24) is the most potent melanocortin in this model, alpha-MSH and [Nle4,D-Phe7]alpha-MSH and ACTH-(4-10) are quite effective as well. As ACTH-(4-10) is a rather weak agonist of all melanocortin receptors, it is difficult to determine via which of the melanocortin receptors the melanocortins bring about this effect. Research into the nature of the receptors involved in the various cardiovascular effects of the melanocortins would greatly benefit from the availability of selective melanocortin receptor antagonists.

Plasma marinobufagenin-like and ouabain-like immunoreactivity in adrenocorticotropin-treated rats

Recently, an endogenous digitalis-like factor (EDLF) was shown to be stimulated in corticotropin (ACTH) hypertension in the rat. We have shown that mammalian plasma contains a vasoconstrictor Na,K-ATPase inhibitor, which cross-reacts with an antibody to amphibian EDLF, marinobufagenin. In the present experiment, the effect of 8 days of intramuscular ACTH treatment (0.5 mg/kg/day) of male Fisher 344 x NB rats on blood pressure, plasma ouabain-like and marinobufagenin-like immunoreactivity, and on the activity of Na,K-ATPase in aortic sarcolemma were studied. The ACTH treatment for 8 days resulted in increased systolic blood pressure (151 +/- 12.4 v 121 +/- 4.0 mm Hg, P < .01), inhibition of Na,K-ATPase in aortic sarcolemma (2.99 +/- 0.35 v 5.43 +/- 0.17 micromol ADP/mg(prot)/h), and increases in plasma concentration of marinobufagenin-like (0.44 +/- 0.06 v 0.21 +/- 0.05 nmol/L), but not ouabain-like (0.09 +/- 0.01 v 0.10 +/- 0.04 nmol/L) immunoreactivity. In dissociation enhanced lanthanide fluoroimmunoassay (DELFIA), serial dilutions of plasma from ACTH-treated rats extracted with 25% and 80% acetonitrile, respectively, demonstrated parallelism to the calibration curves of ouabain and marinobufagenin. These findings suggest that an endogenous bufodienolide Na,K-ATPase inhibitor, rather than an endogenous ouabain-like compound, is increased after 8 days of treatment of rats with ACTH.

Adrenocorticotrophin dose-response relationships in the rat: haemodynamic, metabolic and hormonal effects

OBJECTIVE

To determine adrenocorticotrophin dose-response relationships for increase of blood pressure and metabolic parameters of the Sprague-Dawley rat.

METHODS

We injected 120 male Sprague-Dawley rats twice daily subcutaneously for 10 days with 0.5, 1, 5, 50, 100, 200 or 500 microg/kg synthetic adrenocorticotrophin per day (all n = 10) or subjected them to sham injection (0.9% NaCl; n = 50). Systolic blood pressure, 24 h food intake, water intake, urine volume and body weight were measured. Data from a further 45 rats treated with 500 microg/kg per day adrenocorticotrophin in previous studies were included in the blood pressure analyses. After we had killed these rats, their organ weights (kidney, heart, adrenal) and plasma electrolyte, adrenocorticotrophin and serum corticosterone concentrations were measured.

RESULTS

On the final day of treatment systolic blood pressure of sham-injection control rats was 123 +/- 1 mmHg (n = 50). Compared with sham treatment, a low dose of adrenocorticotrophin (1 microg/kg per day) increased systolic blood pressure from 122 +/- 1 to 130 +/- 2 mmHg (P < 0.001) without any metabolic effects, whereas a high dose of adrenocorticotrophin (500 microg/kg per day) increased systolic blood pressure from 121 +/- 1 to 150 +/- 2 mmHg (P < 0.001, n = 55) with increases in intake of water and urine volume (P < 0.001, n = 10) and a decrease in body weight (P < 0.001, n = 10). Plasma adrenocorticotrophin and serum corticosterone concentrations for the sham-injection control group were 162 +/- 12 pg/ml (36 +/- 3 pmol/l) and 376 +/- 18 ng/ml (1038 +/- 50 nmol/l), respectively. Plasma adrenocorticotrophin concentration was elevated by injections of 100 (P < 0.05), 200 (P < 0.01) and 500 microg/kg adrenocorticotrophin per day (P = 0.001). Serum corticosterone concentration was not significantly different from that of sham-injection rats with 0.5-5 microg/kg adrenocorticotrophin per day but was increased by injection of 50-500 microg/kg adrenocorticotrophin per day (P < 0.001).

CONCLUSIONS

These results define 1 microg/kg adrenocorticotrophin per day, administered subcutaneously, as the threshold dose for causing a rise in blood pressure in the rat Thus administration of adrenocorticotrophin increases systolic blood pressure at doses that induce minimal adrenocorticotrophin metabolic effects. Administration of a low dose of adrenocorticotrophin to the rat is a suitable model for stress-induced hypertension.

Hemodynamic profile of corticotropin-induced hypertension in the rat

OBJECTIVES

To examine hemodynamic variables in corticotropin-induced hypertension in rats and the effects of reversal of the hypertension by L-arginine on the hemodynamic profile.

METHODS

Sixty male Sprague-Dawley rats were randomly divided into four groups: sham treatment (0.9% NaCl, injected subcutaneously); 0.5 mg/kg corticotropin per day, subcutaneously; 0.6% L-arginine in food plus sham; and L-arginine plus corticotropin. Systolic blood pressure, water and food intakes, urine volume, and body weight were measured every second day. After 10 days mean arterial blood pressure was measured by intra-arterial cannulation, and cardiac output, and renal, mesenteric, and hindquarter blood flows were determined using transonic small animal flowmeters.

RESULTS

Injection of corticotropin increased blood pressure, water intake, urine volume, and plasma sodium concentration, and decreased body weight and plasma potassium concentration. It increased cardiac output (P < 0.01), mesenteric blood flow (P < 0.05), and renal vascular resistance (P < 0.05), and decreased renal blood flow (P < 0.05), but did not change calculated total peripheral resistance, hindquarter blood flow, mesenteric or hindquarter vascular resistance. L-arginine prevented corticotropin-induced rises in blood pressure (P < 0.001) and renal vascular resistance (P < 0.05), and a fall in renal blood flow (P < 0.05), but did not affect other hemodynamic variables.

CONCLUSION

The hemodynamic profile of corticotropin-induced hypertension in the rat is characterized by a rise in cardiac output and renal vascular resistance, a fall in renal blood flow, but no change in total peripheral resistance, hindquarter blood flow, mesenteric vascular resistance, or hindquarter vascular resistance. L-arginine prevented corticotropin-induced rises both in blood pressure and in renal vascular resistance in the rat. These data suggest that the increase in renal vascular resistance might play a role in corticotropin-induced hypertension in the rat.

The stress hormone adrenocorticotropin enhances sympathetic outflow to the muscle vascular bed in humans

OBJECTIVE

To examine the role of adrenocorticotropin in the regulation of the sympathetic outflow to the muscle vascular bed in healthy female humans.

DESIGN

Eight healthy, nonsmoking female subjects (aged 18-33 years) were examined before and after injection of 0.25 mg adrenocorticotropin 1-24 or placebo according to a balanced, double-blind cross-over protocol.

METHODS

Muscle sympathetic nerve activity, arterial pressure, and heart rate were continuously recorded both under basal conditions and during a 50 min period after injection of each substance. Furthermore, sympathoexcitatory capacities of inspiratory apneas and cold pressure tests performed before and after injection of adrenocorticotropin were determined.

RESULTS

The injection of adrenocorticotropin rapidly increased burst frequency of muscle sympathetic nerve activity (P < 0.01). The maximal effect of adrenocorticotropin, with an increase in burst frequency of 63%, occurred during the third minute after injection and waned subsequently, but muscle sympathetic nerve activity remained significantly increased during the first 10 min after injection. The stimulatory effect of adrenocorticotropin had disappeared 40 min after injection. The sympathoexcitatory capacity of a maximal inspiratory apnea and a cold pressure test, respectively, remained unchanged 10 and 45 min after the administration of adrenocorticotropin compared with control. Neither blood pressure nor heart rate was significantly affected by administration of the peptide.

CONCLUSIONS

The data establish that the stress hormone adrenocorticotropin acutely increases sympathetic outflow to the muscle vascular bed in female humans. This effect is most likely mediated via central nervous system autonomic centers. The influence of adrenocorticotropin on the sympathetic nervous system might contribute to the alteration of response to stress in the course of the development of hypertension and could also add to the hypertensiogenic effects of corticosteroids and mineralocorticoids in states with excess adrenocorticotropin.

Mechanisms of cortisol-induced hypertension in humans

There is emerging evidence that cortisol plays a significantly greater role in human hypertension than previously thought. Apart from the well recognized role of cortisol in the hypertension of Cushing's syndrome, local cortisol excess has been recognized as responsible for rare forms of hypertension such as apparent mineralocorticoid excess and licorice abuse and more recently implicated in the hypertension of chronic renal failure, hypertension related to low birth weight and essential hypertension. Although cortisol-induced hypertension is characterized by sodium retention and volume expansion, studies with synthetic glucocorticoids or sodium restriction suggest that the hypertension is, to a substantial degree, independent of sodium and volume. Increase in cardiac output is not essential for cortisol-induced blood pressure rise but the precise role of increases in total or regional peripheral resistance as a primary mechanism has nto been determined. Increased pressor responsiveness, particularly to catechols, is a prominent feature but whether these changes are sufficient to account for the hypertension remains unclear. There is no evidence for increased sympathetic nervous activity as judged by measurements of plasma catcholamines, neuropeptide-Y, or resting noradrenaline spillover rate. Responses to mental stress or maximal hand-grip are unchanged and baroreflex sensitivity is increased. Octreotide profoundly reduced the elevated plasma insulin concentrations seen with cortisol administration but had no effect on the rise in blood pressure.

Blood pressure and metabolic effects of 18-oxo-cortisol in sheep

18-Oxo-cortisol (18-oxo-F) has been isolated from the urine of subjects with primary aldosteronism. This study examines the pressor, mineralocorticoid and glucocorticoid effects of 18-oxo-F in conscious sheep--a well studied species for the assessment of the pressor effect of steroid hormones. 18-oxo-F (24 mg/day i.v. for 5 days, n = 3) increased mean arterial pressure MAP (64 +/- 2 mmHg control and 75 +/- 6 mmHg on day 5 P less than 0.001). There was no change in heart rate. Plasma [K+] decreased from a control of 4.3 +/- 0.1 mmol/l control to 2.9 +/- 0.3 mmol/l on day 5 (P less than 0.001). Urinary Na+ excretion decreased on the first infusion day (233 +/- 18 mmol/day control and 124 +/- 20 mmol/day on infusion day 1 P less than 0.001). Urinary K+ excretion was reduced on days 1, 4 and 5 of the infusion. Thus in sheep, 18-oxo-F increased blood pressure associated with in vivo evidence of mineralocorticoid activity.

Structure-activity relationships for blood pressure effects of prednisolone in sheep

This study investigated the effect of 5 day infusions of 6 alpha and 9 alpha-fluoro and 16 alpha, 17 alpha-acetal analogues of prednisolone on blood pressure in conscious sheep. In vivo mineralocorticoid (MC) and glucocorticoid (GC) activities of these steroids were also measured. Prednisolone (100 mg/d) produced a small increase in mean arterial pressure associated with increased fasting plasma [glucose] and polyuria, but had no MC activity. 9 alpha-fluoro substitution greatly enhanced both the pressor and MC activity of prednisolone. The effect of 9 alpha-fluoro substitution on pressor activity was not affected by beta-methylation at C-16 (betamethasone), but was attenuated by either alpha-hydroxylation or alpha-methylation at C-16 (triamcinolone and dexamethasone, respectively). The effect of 9 alpha-fluoro substitution on MC activity as determined by urinary Na excretion was not altered by a methyl group at C-16 in either alpha or beta configuration but the MC activity was attenuated by an alpha-hydroxyl group at C-16. In contrast, 6 alpha-fluoro substitution had little influence on pressor, MC and GC activities. 16 alpha, 17 alpha-acetonide and 16 alpha, 17 alpha-butylidenedioxy substitution increased the pressor activity of parent compounds, but had no influence on either GC or MC activity. This study demonstrates a dissociation between the pressor effects and the MC and GC activities associated with steroid administration and provides further evidence to support the concept of 'hypertensinogenic' class of steroid activity which can be distinguished from their MC and GC activity.

Modification of the haemodynamic effects of ACTH by angiotensin II in sheep

The study was performed to examine the hypothesis that adrenocorticotrophic hormone (ACTH) induced hypertension in sheep would be enhanced if the blood level of angiotensin II (ANG II), normally suppressed during ACTH administration, was kept at control levels by intravenous infusion of ANG II. Administration of ACTH at 1.0 microgram/kg/day for 6 days produced a half maximum rise in mean arterial pressure, delta 14 mmHg, associated with hypokalaemia and initial urinary sodium retention. A rate of ANG II infusion, (0.9 microgram/kg/day) for 6 days, was contrived to produce a small increase in peripheral resistance and mean arterial pressure, delta 10 mmHg. Pressor responses to concomitant infusion of ACTH and ANG II were additive, delta 25 mmHg. There was no potentiation of ACTH hypertension by ANG II in the sheep.

Blood pressure responses to ACTH and adrenaline infusions in dogs

The hypothesis that interactions between adrenaline and adrenal cortical hormones may increase arterial blood pressure has been examined in trained dogs with chronically indwelling aortic and venous catheters. The dogs received continuous infusions for 4 days of ACTH (400 micrograms/day), or adrenaline (8 mg/day) or both ACTH and adrenaline, or saline vehicle. Compared to pre-infusion control values, ACTH raised mean arterial pressure by 14.9 +/- 2.2 mmHg by the 4th day of infusion, adrenaline infused alone had no effect (-0.2 +/- 3.9 mmHg), and ACTH and adrenaline infused together raised pressure 13.1 +/- 3.2 mmHg (not significantly different to ACTH alone). ACTH increased water consumption, Na+ and K+ excretion and creatinine clearance by the 4th day of infusion and these effects were not significantly altered when adrenaline was also infused. Thus adrenaline did not potentiate the hypertension produced by ACTH administration.