SUMMARY To test whether central neurogenic factors participate in blood pressure elevation in primary hypertension, we studied the concentrations of: norepinephrine, epinephrine and dopamine-beta-hydroxylase (DBH) in cerebrospinal fluid (CSF); and norepinephrine, epinephrine, DBH and plasma renin activity (PRA) in plasma of 22 subjects (seven with primary hypertension, 11 normotensive patients with non-systemic neurological disorders, and four with secondary hypertension). Plasma and CSF norepinephrine (NE) were increased in primary hypertensives compared to normotensives. Cerebrospinal fluid norepinephrine was related to diastolic blood pressure, and systolic blood pressure when normotensive and primary hypertensives were taken together. The CSF norepinephrine of primary hypertensive patients was correlated with natural log PRA. The CSF norepinephrine was correlated inversely with age in primary hypertensive patients but not in the normotensive subjects. The low CSF norepinephrine and epinephrine, despite markedly increased plasma NE and epinephrine, in two patients with pbeochromocytoma, indicate a blood-brain barrier for these neurohormones. The observations support the view that the central sympathetic nervous system is involved in the pathogenesis of primary hypertension, particularly in younger patients. 1 " Hyperactivity of the central sympathetic nervous system might raise plasma norepinephrine and lead to the development of hypertension. Because of an efficient blood-brain barrier to norepinephrine (NE) it seems possible to evaluate central nervous system NE release by measuring NE in cerebrospinal fluid (CSF). Therefore, in this study, we compared CSF NE concentrations from patients with primary hypertension with those from normotensive patients with various neurological disorders. We found increased NE in CSF and plasma from the hypertensive group, which suggests that central sympathetic hypertonicity is associated with raised peripheral sympathetic nerve tone and elevated blood pressure in younger patients with primary hypertension.

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