Summary
The short- and long-term effects of diuretic treatment with chlorthalidone 50 mg/day on haemodynamic and hormonal parameters in patients with essential hypertension (WHO grade I) were investigated. After three days of treatment, all patients showed a rise in plasma renin activity (PRA), plasma aldosterone (PA), urinary norepinephrine excretion (UNE) and heart rate (HR), and a decrease in body weight (BW) and extracellular volume (ECV) and blood volume (BV); the change in blood pressure (BP) was variable. The changes in BP were correlated with those in BV. After three months of therapy, the signs of volume depletion tended to fade, but the lower ECV persisted. In contrast to the 4-day study, after three months the change in BP correlated inversely with changes in ECV and renin dependency (saralasin response), and positively with PRA and changes in UNE. It is concluded that the BP response to diuretic treatment is determined by the adaptation with time of the haemodynamic reactions to the volume-depleted state. Whether this adaptation will take place cannot be predicted from the control values of the parameters studied, or from acute changes observed during the first days of treatment.
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References
Ambard L, Beaujard E (1904) Causes de l'hypertension arterielle. Arch Gen Med 1: 520–534
Tobian L (1967) Why do thiazide diuretics lower blood pressure in essential hypertension? Annu Rev Pharmacol 7: 399–408
Crane MG, Harris JJ, Johns VJ (1972) Hyporeninemic hypertension. Am J Med 52: 457–466
Vaughen ED, Laragh JH, Gavras I, Bühler FR, Gavras H, Brunner HR, Baer L (1973) Volume factor in low and normal renin essential hypertension. Am J Cardiol 32: 523–532
Ibsen H, Leth A, Hollnagel H, Kappelgaard AM, Damkjaer M, Christensen NJ, Giese J (1979) Renin-angiotensin system in mild essential hypertension. Acta Med Scand 205: 547–555
Leonetti G, Terzoli L, Sala C, Bianchini C, Sernesi L, Zanchetti A (1978) Relationship between the hypotensive and renin-stimulating action of diuretic therapy in hypertensive patients. Clin Sci Mol Med 55: 307s-309s
Brummelen P van (1979) Haemodynamic and metabolic effects of long-term thiazide treatment in essential hypertension. Thesis Leiden
Weber MA, Drayer JIM, Rev A, Laragh JH (1977) Disparate patterns of aldosterone response during diuretic treatment of hypertension. Ann Intern Med 87: 558–563
Falch DK, Quist Paulsen A, Odegaard AE, Norman N (1979) Central and renal circulation, renin and aldosterone in plasma during chlorthalidone treatment in essential hypertension. Curr Ther Res 26: 372–382
Carvalho JCR de, Dunn FG, Lohmöller G, Frohlich ED (1978) Hemodynamic correlates of prolonged thiazide therapy: comparison of responders and non responders. Clin Pharmacol Ther 22: 875–880
Laverty R, Taylor KM (1968) The fluorometric assay of catecholamines and related compounds — improvements and extensions to the hydroxyindole technique. Anal Biochem 22: 269–279
Anton AH, Sayre DF (1962) A study of the factors affecting the aluminum oxide-trihydroxy indole procedure for the analysis of catecholamines. J Pharmacol Exp Ther 138: 360–375
Fleuren HLJ, Rossum JM van (1978) Determination of chlorthalidone in plasma, urine and red blood cells by gas chromatography with nitrogen detection. J Chromatogr 152: 41–54
Planque BA de, Geyskes GG, Dongen R van, Dorhout Mees EJ (1965) Simultaneous determination of extra cellulair volume and blood volume with the volumetron. Clin Chim Acta 11: 270–277
Haber E, Koerner T, Page LB, Kliman B, Purnode A (1969) Application of a radioimmunoassay for angiotensin I to the physiologic measurement of plasma renin activity in normal human subjects. J Clin Endocrinol 29: 1349–1355
Ogihara T, Linuma K, Nishy K, Arakawa Y, Takagi A, Kurata K, Miyai K, Kumahara Y (1977) A non-chromatographic non-extraction radioimmunoassay for serum aldosterone. J Clin Endocrinol Metab 45: 726–731
Conway J, Lauwers P (1960) Hemodynamic and hypotensive effects of long-term therapy with chlorothiazide. Circulation 21: 21–27
Bourgoignie JJ, Catanzaro FJ, Perry HM (1968) Reninangiotensin-aldosterone system during chronic thiazide therapy of benign hypertension. Circulation 37: 27–35
Editorial (1968) Plasma volume in essential hypertension. N Engl J Med 278: 14, 793
Leth A (1970) Changes in plasma and extracellulair fluid volumes in patients with essential hypertension during long-term treatment with hydrochlorothiazide. Circulation 42: 479–485
Weidmann P, Beretta-Picolli C, Keusch G, Glück Z, Mujagic M, Grimm M, Meier A, Ziegler WH (1979) Sodium volume factor, cardiovascular reactivity and hypotensive mechanism of diuretic therapy in mild hypertension associated with diabetes mellitus. Am J Med 67: 779–784
Tweeddale MG, Ogilvie RI, Ruedy J (1977) Antihypertensive and biochemical effects of chlorthalidone. Clin Pharmacol Ther 22: 519–527
Materson BJ, Oster JR, Michael UF, Bolton SM, Burton ZC, Stambaugh JE, Morledge J (1978) Dose response to chlorthalidone in patients with mild hypertension. Clin Pharmacol Ther 24: 192–198
Gavras H, Ribeiro AB, Gavras I, Brunner HR (1976) Reciprocal relation between renin dependency and sodium dependency in essential hypertension. N Eng J Med 295: 1278–1283
Guyton AC, Coleman TG, Cowley AW, Manning RD, Norman RA, Ferguson JD (1974) A systems analysis approach to understanding long-range arterial blood pressure control and hypertension. Circ Res 35: 159–176
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Roos, J.C., Boer, P., Koomans, H.A. et al. Haemodynamic and hormonal changes during acute and chronic diuretic treatment in essential hypertension. Eur J Clin Pharmacol 19, 107–112 (1981). https://doi.org/10.1007/BF00568396
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DOI: https://doi.org/10.1007/BF00568396