Whole body elemental composition in patients with essential hypertension.

The whole body content of sodium, chlorine and potassium has been measured in 30 patients with essential hypertension, using the techniques of in vivo neutron activation analysis and whole body counting. Total exchangeable sodium and potassium were also measured, and found to be well correlated with the total body amounts of these elements. Comparable measurements on normotensive subjects could not be obtained, but results for both elements were similar to those expected on the basis of published values for healthy normal body composition.

Intravenous labetalol in the treatment of severe hypertension.

1 We have compared, in patients with severe hypertension, the administration of intravenous labetalol by single rapid injection, by repeated bolus injections, and by incremental infusion. 2 Incremental infusion was the most consistently (albeit not invariably) effective method, and that least prone to cause side-effects. 3 An occasional very marked decrease in blood pressure was seen with all these techniques but least often with incremental infusion.

Captopril treatment: inter-dose variations in renin, angiotensins I and II, aldosterone and blood pressure.

1 The ability of captopril, 150 mg three times daily by mouth, to effect sustained reduction in plasma angiotensin II, with converse increases in circulating angiotensin I, and in active, inactive and total renin concentrations, has been assessed. 2 During prolonged treatment with captopril alone, and 12 h after the last dose of the drug, plasma angiotensin II remained approximately one-sixth of basal concentrations, while angiotensin I and renin concentrations were proportionately increased. However, further increases in angiotensin I, and in active, inactive and total renin concentrations, were seen 2 and 6 h after the morning dose of 150 mg captopril.

Captopril in the management of hypertension with renal artery stenosis: its long-term effect as a predictor of surgical outcome.

Fifteen patients with hypertension and unilateral renal artery disease were treated with captopril alone; 10 came to operation and were later assessed postoperatively with no drug treatment. Captopril caused both immediate and sustained decreases in plasma angiotensin II and aldosterone, with increases in plasma active renin and blood angiotensin I concentrations. Decrements in systolic and diastolic pressure 2 hours after the first dose of captopril were closely correlated with the initial decreases in plasma angiotensin II.

Captopril in renovascular hypertension: long-term use in predicting surgical outcome.

The angiotensin converting-enzyme inhibitor captopril was used as long-term preoperative treatment in a series of hypertensive patients with unilateral renal arterial disease. There were immediate and sustained falls in plasma angiotensin II and aldosterone concentrations, with converse increases in circulating renin and angiotensin I. In patients with sodium and potassium deficiency and secondary aldosterone excess before treatment captopril corrected the sodium and potassium deficits; in these cases the initial hypotensive response was profound but the later effect was less pronounced.

Response of the renin-angiotensin-aldosterone system to upright tilting and to intravenous frusemide: effect of prior metoprolol and propranolol.

1 Upright tilting in normal volunteers caused increases in plasma active and total renin, angiotensin II and aldosterone; a slight but significant fall in inactive renin accompanied these changes. 2 The alterations in the renin-angiotensin-aldosterone system on tilting took up to 1 h upright to become fully established. 3 Large intravenous doses of propranolol or metoprolol attenuated, without abolishing, the rises in active renin, angiotensin II, and aldosterone; the attenuation was most evident soon after tilting and was largely overcome by 1 h upright.

Familial antithrombin III deficiency.

Antithrombin III is the major physiological inhibitor of the coagulation mechanism and a deficiency of this protein results in a marked predisposition to venous thromboembolic disease. Three Scottish families with a deficiency of this protein are described and other reported families are reviewed. The properties, functions and methods of assay of antithrombin III are outlined; the molecular abnormalities, inheritance, clinical and laboratory characteristics of antithrombin III deficiency are described, and the use of antithrombotic drugs and human antithrombin III concentrates in this deficiency is discussed.

Pre-operative localization of aldosterone-secreting adrenal adenomas.

Techniques for pro-operative localization of aldosterone-secreting adrenal adenomas were studied in thirty-seven patients, each with hypertension and biochemical evidence of primary hyperaldosteronism and each later having adrenal surgery (thirty-two adenomas, five bilateral hyperplasia). Bilateral adrenal vein catheterization was attempted in all cases; it was successful on the left side in all patients and in 92% of cases on the right. Adrenal vein plasma samples were obtained from the left side in 92% and from the right in 73% of cases.

The effect of oral prazosin on blood pressure and plasma concentrations of renin and angiotensin II in man.

1. We studied the effect of oral prazosin on blood pressure, plasma active renin and angiotensin II in 16 recumbent hypertensive patients between 09.00 and 12.

Effects of change in body posture on plasma and serum electrolytes in normal subjects and in primary aldosteronism.

We observed that change in body posture from the supine to the erect position in normal volunteers was associated with a rise in circulating potassium and a fall in sodium concentrations, irrespective of whether the electrolytes were measured in serum or plasma, or whether head-up tilt or ambulation was used. In patients with primary aldosteronism, the fall in serum sodium and rise in serum potassium with ambulation tended to obscure the characteristic electrolyte abnormalities of that syndrome. These changes in potassium and sodium could contribute to the rise in aldosterone secretion on orthostasis.

Response of aldosterone and 18-hydroxycorticosterone to angiotensin II in normal subjects and patients with essential hypertension, Conn's syndrome, and nontumorous hyperaldosteronism.

Dose-response curves relating plasma angiotensin II (AII) concentration during AII infusion to blood pressure (BP), to plasma aldosterone, and to plasma 18-hydroxycorticosterone were compared in normal subjects and in patients with essential hypertension, Conn's syndrome, and nontumorous hyperaldosteronism. The BP response was steeper than normal in patients with Conn's syndrome and essential hypertension. Before infusion, mean plasma aldosterone concentration was approximately four-fold higher in Conn's syndrome than in the normal group, while that of 18-hydroxycorticosterone was ninefold higher.

Assessment of total and divided renal plasma flow by 123I-hippuran renography.

We studied 23 patients with suspected renal hypertension, including 12 with renal artery stenosis, or occlusion. Total effective renal plasma flow (ERPF) was measured in all patients by conventional p-aminohippurate (PAH) clearance and by 123I-hippuran clearance performed on the same day. A close correlation between the two techniques was obtained (r = 0.

Lipid relation ships in dialysis and renal transplant patients.

The relationship of high density lipoprotein cholesterol (HDL-CHOL) to other lipid fractions and the factos influencing post-transplant hyperlipidaemia have been explored in 28 chronic haemodialysis patients and 20 stable renal allograft recipients. In both groups of patients mean triglyceride (TG) and very low density lipoprotein cholesterol VLDL-CHOL) were elevated, but total CHOL and low density lipoprotein cholesterol (LDL-CHOL) were elevated only in transplanted patients. HDL-CHOL was uniformly low in dialysis patients irrespective of TG, whereas after transplantation mean HDL-CHOL was normal and varied inversely with TG and VLDL-CHOL.

Coronary heart disease in North-East Scotland a study of genetic and environmental variation in serum lipoproteins and other variables.

1. Serum lipoprotein concentrations and other variables such as relative weight, skinfold thickness, blood pressure, serum glucose, uric acid, fibrinogen smoking habits, etc. have been recorded on about 700 persons, including about 200 survivors of myocardial infarction under age 50 years, 250 of their relatives and 250 unrelated controls.

Severe hypokalaemia with paralysis induced by small doses of liquorice.

A patient, who presented with a flaccid quadriplegia due to profound hypokalaemia, is described. Hypokalaemia and myoglobinuria were caused by the ingestion of small amounts of liquorice contained in a laxative preparation. Subsequent controlled administration of small amounts of this preparation induced marked hypokalaemia.

Ischaemic heart disease in young hypertensive women.

The association between hypertension and ischaemic heart disease was explored in a retrospective analysis of 50 severely hypertensive premenopausal women (presenting diatolic pressure greater than or equal to 120 mmHg) under 45 years of age who were seen over a seven-year period. Twenty-two per cent of these patients had angina pectoris, and 38 per cent had Minnesota code 4-1 or 5-1 changes on the resting electrocardiogram. The contribution of other risk factors, including smoking habits, was assessed: 72 per cent of the patients smoked; significantly less smoking was found among two groups of age-matched women with less severe hypertension [diastolic pressures of 90 to 104 mmHg (n=50) and 105 to 119 mmHg (n=50)].

Relationship between exchangeable sodium and blood pressure in different forms of hypertension in man.

1. Arterial pressure and exchangeable sodium (NaE) were measured in patients with Conn's syndrome, essential hypertension, renal artery stenosis and chronic renal failure. Comparison was made with a control group.