Re-Examination of the Hemodynamics of Hypertension

Ed, Frohlich; Rc, Tarazi; Hp, Dustan

doi:10.1097/00000441-196901000-00002

Cited by 209 publications

(47 citation statements)

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“…The mode of action of calcium antagonist drugs in reducing vascular smooth muscle tone (Massingham, 1973) and thus the raised peripheral resistance which is the consistent haemodynamic abnormality in essential hypertension (Frohlich et al, 1969;Lund-Johansen, 1967), makes these drugs potentially useful in the treatment of this condition. However, they share many of the side effects of other peripheral vasodilators, including reflex tachycardia, orthostatic hypotension and fluid retention.…”

Section: Discussionmentioning

confidence: 99%

24 h blood pressure control with the once daily calcium antagonist, amlodipine.

Heber

Brigden

Al-Khawaja

et al. 1989

Brit J Clinical Pharma

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1 Amlodipine is a novel calcium antagonist which, although pharmacologically similar to other dihydropyridine calcium antagonists, has a long plasma half-life, permitting steady state blood levels to be achieved with a once-daily dose regimen. 2 We have performed a study to examine the effects of this drug on the blood pressure of hypertensive patients over a 24 h period. After a placebo run-in, the drug was administered to 11 patients at a starting dose of 5 mg, and increased to 10 mg after 2 weeks of treatment if the cuff diastolic blood pressure response was unsatisfactory. Cuff measurements were made at entry, after 2 weeks treatment with placebo, after 2 weeks on amlodipine 5 mg once daily, and after a further 4 weeks on amlodipine 5 mg or 10 mg once daily. Intraarterial blood pressure recordings were made at the end of the placebo phase and at completion of the study. 3 Mean supine blood pressure measured sphygmomanometrically was 168/103 (n = 11) mm Hg at entry, 169/104 (n = 11) mm Hg at the end of the placebo phase, 153/95 (n = 11) mm Hg after 2 weeks of treatment and 146/92 (n = 11) mm Hg at the end of the study. Blood pressure curves plotted for each phase of the study revealed an effective 24 h duration of action. Mean daytime blood pressure was reduced from 165/103 to 147/89 mm Hg (P < 0.05, n = 10), and mean night-time blood pressure was reduced from 137/79 to 121/69 mm Hg (P < 0.05, n = 10). There was no change in heart rate. 4 One patient developed ankle swelling which would have required discontinuation of medication had she not already been at the end of the study. The drug was otherwise well tolerated. 5 These results indicate that amlodipine is effective as a once daily antihypertensive agent, and is well tolerated.

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Section: Discussionmentioning

confidence: 99%

24 h blood pressure control with the once daily calcium antagonist, amlodipine.

Heber

Brigden

Al-Khawaja

et al. 1989

Brit J Clinical Pharma

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“…The use of rats in these experiments could, however, offer several advantages. In addition to the obvious economic reason for using rats, the availability of several kinds for experimental hypertension, including some genetic types (4), makes the rat the most suitable species for hypertension research.…”

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confidence: 99%

Direct Relationship between Renal Arterial Pressure and Plasma Ren n Activity in Conscious Rats

Imagawa

Miyauchi

Satoh

1984

Japanese Journal of Pharmacology

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“…[23][24][25] This raises a critical and perplexing question, how does abnormal pressure natriuresis lead to the sustained increase in total peripheral resistance that hemodynamically sustains the increased BP in many if not most cases of hypertension?…”

Section: Can the Pressure Natriuresis Theory Of Chronic Hypertension mentioning

confidence: 99%

Logical Issues With the Pressure Natriuresis Theory of Chronic Hypertension

Kurtz

DiCarlo

Morris³

2016

American Journal of Hypertension

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The term “abnormal pressure natriuresis” refers to a subnormal effect of a given level of blood pressure (BP) on sodium excretion. It is widely believed that abnormal pressure natriuresis causes an initial increase in BP to be sustained. We refer to this view as the “pressure natriuresis theory of chronic hypertension.” The proponents of the theory contend that all forms of chronic hypertension are sustained by abnormal pressure natriuresis, irrespective of how hypertension is initiated. This theory would appear to follow from “the three laws of long-term arterial pressure regulation” stated by Guyton and Coleman more than 3 decades ago. These “laws” articulate the concept that for a given level of salt intake, the relationship between arterial pressure and sodium excretion determines the chronic level of BP. Here, we review and examine the recent assertion by Beard that these “laws” of long-term BP control amount to nothing more than a series of tautologies. Our analysis supports Beard’s assertion, and also indicates that contemporary investigators often use tautological reasoning in support of the pressure natriuresis theory of chronic hypertension. Although the theory itself is not a tautology, it does not appear to be testable because it holds that abnormal pressure natriuresis causes salt-induced hypertension to be sustained through abnormal increases in cardiac output that are too small to be detected.

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Re-Examination of the Hemodynamics of Hypertension

Cited by 209 publications

References 0 publications

24 h blood pressure control with the once daily calcium antagonist, amlodipine.

24 h blood pressure control with the once daily calcium antagonist, amlodipine.

Direct Relationship between Renal Arterial Pressure and Plasma Ren n Activity in Conscious Rats

Logical Issues With the Pressure Natriuresis Theory of Chronic Hypertension

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