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Biomedical subjects

T A Kotchen

Publications and source records attributed to T A Kotchen.

At least 73 records · Page 4Linked to original sources
PubMed1989

Baroreceptor sensitivity in prehypertensive young adults.

Decreased baroreceptor reflex sensitivity has been implicated in the pathogenesis of hypertension. The purpose of this study is to determine if alterations of baroreceptor function precede the development of hypertension in humans. Baroreceptor function was evaluated in 13 young adult white men with relatively high blood pressures sustained for 12 to 15 years and 12 age-matched men with sustained relatively low blood pressures. High pressure baroreceptor activity was evaluated by measuring change in pulse interval in response to decreases and increases of arterial pressure, induced by graded infusions of nitroprusside and angiotensin II, respectively. In response to both agents, baroreceptor slopes did not differ in the high and low blood pressure groups. Plasma norepinephrine also increased similarly in both blood pressure groups in response to nitroprusside. To study low-pressure baroreceptor function, responses to graded levels of lower-body negative pressure (LBNP) were measured. Comparing both blood pressure groups, there were similar increases of heart rate, total peripheral resistance, and plasma norepinephrine in response to LBNP. Both blood pressure groups also had similar increases of heart rate and blood pressure in response to isometric (handgrip) exercise. Thus, high-pressure and low-pressure baroreceptor function is not altered in prehypertensive young adults. However, continued follow-up will be required to determine if these individuals with sustained relatively high blood pressures are truly prehypertensive.

Adult↗
PubMed1989

Relative contributions of dietary Na+ and Cl- to salt-sensitive hypertension.

The effect of dietary NaCl on blood pressure has generally been attributed to the sodium ion. However, recent evidence indicates that the anion accompanying sodium plays an important role in determining the magnitude of the blood pressure increase in response to a high dietary intake of NaCl. The purpose of this review is to describe studies of blood pressure responses in several experimental models of salt-sensitive hypertension and in hypertensive humans to selective dietary sodium loading (without chloride) and to selective dietary chloride loading (without sodium). The full expression of salt sensitivity depends on high dietary intakes of both sodium and chloride. This observation has implications for understanding mechanisms contributing to NaCl-induced hypertension in the susceptible host.

Adenosine Triphosphatases↗
PubMed1989

Cardiovascular responses to alpha adrenergic agents in chronically-exercised spontaneously hypertensive rats.

The influence of treadmill exercise training on cardiovascular regulation was investigated in spontaneously hypertensive rats (SHR) of Okamoto strain during their 8th to 18th week of life. Non-exercising age-matched SHR and Wistar-Kyoto (WKY) rats served as cage controls. Resting systolic blood pressure (SBP), heart rate (HR) and weight changes were measured in the three groups during the training period. At the completion of the training period (week 18), the trained SHR had SBP values of 164 +/- 4 mm Hg and HR values of 388 +/- 8 beats per minute, which were significantly less than (P less than 0.05) those values recorded for the control SHR (SBP = 186 +/- 3 mm Hg; HR = 422 +/- 11 bpm). The influence of exercise on baroreceptor regulation of HR was evaluated in anesthetized animals from all three groups. Phenylephrine-induced increases in mean arterial blood pressure (MAP) produced significantly greater (P less than 0.05) reflex decreases in HR in the trained SHR versus the sedentary SHR. No significant difference in baroreflex sensitivity values were noted between the WKY and trained SHR. Additionally, norepinephrine infusion produced significantly smaller (P less than 0.05) pressor responses in trained versus sedentary SHR. We conclude that exercise training significantly reduces resting SBP and HR while modifying the baroreceptor regulation of HR and cardiovascular responses to adrenergic agents in the SHR.

Animals↗
PubMed1989

Treatment of high blood pressure in the young.

Children with high normal or high BP should also be evaluated for other cardiovascular risk factors, and interventions should address overall cardiovascular risk. Nonpharmacologic interventions include weight reduction when appropriate, avoidance of dietary salt excess, and dynamic exercise. Drug treatment should be required in a minority of children with hypertension. There are concerns about the longterm effects of drug therapy on lipid and carbohydrate metabolism and on physical and cognitive growth and development. Beta adrenergic antagonists and diuretics are usually the first line drugs to be added to the nonpharmacologic therapeutic strategies for BP control in children. After a sufficient period of BP control, a stepped-down approach and discontinuation of drug therapy should be considered.

Antihypertensive Agents↗
PubMed1988

Effects of calcium on renin and aldosterone.

A series of experiments was undertaken to assess the effects of calcium administration, in vivo, on renin and aldosterone secretion. In the anesthetized dog, renin secretion was decreased by renal arterial infusions of calcium chloride and calcium gluconate; aldosterone excretion was not affected. In the sodium chloride-deprived rat, dietary calcium chloride loading decreased plasma renin activity, whereas calcium gluconate did not. Both calcium salts increased aldosterone production. In the non-filtering, denervated, papaverine-treated dog kidney, renin release was stimulated by renal arterial infusion of verapamil. In the rat, chronic oral verapamil administration decreased plasma aldosterone but had no effect on renin. In humans, chronic oral verapamil decreased aldosterone responsiveness to infusion of angiotensin II. Thus, in vivo renin release is inhibited by hypercalcemia and stimulated by blocking calcium transport; conversely, aldosterone production is stimulated by a high calcium intake and inhibited by blocking calcium transport. These effects of calcium on renin and aldosterone may have implications for understanding the putative relation between calcium and hypertension.

Aldosterone↗
PubMed1988

Inhibition of renin by plasma linoleic acid.

The authors have demonstrated previously that human plasma contains an inhibitor(s) of the enzymatic activity of renin. The purpose of this study is to identify the circulating renin inhibitor. Plasma initially was fractionated with preparative sephacryl S-300 chromatography. A fraction with low protein content inhibited the in vitro enzymatic activity of human renin by 76%. The inhibitory activity of this fraction was not altered by boiling and/or acidification. This fraction was applied to an affinity column, using purified mouse submaxillary renin as ligand. The inhibitor was recovered after elution with hypertonic NaCl. Linoleic acid, a previously identified renin inhibitor, was present in this fraction. The authors conclude that circulating linoleic acid inhibits renin. Conceivably, the overall activity of the renin-angiotensin-aldosterone cascade may be modified by alterations of plasma fatty acid concentrations.

Angiotensin I↗
PubMed1988

Dissociation between plasma renin and plasma aldosterone induced by dietary glycine hydrochloride.

We evaluated the effects of selective dietary chloride loading (without sodium) on plasma renin activity (PRA) and plasma aldosterone in the sodium-deprived Sprague-Dawley rat. Three groups of animals were fed one of the following diets for 13 days: 1) low NaCl; 2) high NaCl; or 3) low sodium, high chloride, provided as glycine hydrochloride. Compared with NaCl-deprived animals, PRA and plasma aldosterone were lower (P less than 0.01) in animals fed low sodium high chloride, whereas aldosterone in animals fed glycine hydrochloride was higher (P less than 0.01) than that of NaCl-deprived animals. In contrast, plasma concentrations of corticosterone and 18-hydroxycorticosterone were not increased by selective chloride loading. Glycine chloride-fed animals were acidotic and had elevated plasma concentrations of potassium and ionized calcium. Thus stimulation of aldosterone by selective chloride loading is not related to PRA or ACTH but may be due to a direct effect of acidosis or an indirect effect of acidosis on potassium and/or calcium. Additionally, selective chloride loading appears to stimulate the conversion of 18-hydroxycorticosterone to aldosterone.

18-Hydroxycorticosterone↗
PubMed1988

Failure of salt loading to inhibit tissue norepinephrine turnover in prehypertensive Dahl salt-sensitive rats.

To determine if alterations of electrolyte balance or sympathetic nervous system activity are present in Dahl salt-sensitive rats (DS) before the onset of hypertension, we compared electrolyte balances, extracellular fluid volume (inulin space), plasma volume (radiolabeled albumin), and norepinephrine turnover in peripheral tissues (heart and interscapular brown fat) in prehypertensive DS and Dahl salt-resistant rats (DR). Animals were maintained for 5 to 7 days on either a "normal" or high NaCl diet. Tissue norepinephrine turnover was evaluated by measuring the rate at which norepinephrine content decreased following tyrosine hydroxylase inhibition with alpha-methyl-p-tyrosine. Blood pressure was higher (p less than 0.05) in DS (135 +/- 2 [SE] mm Hg) than in DR (129 +/- 2 mm Hg) and was not affected by the diets. Extracellular fluid volume and net Na+ and Cl- balances did not differ between DS and DR. However, plasma volume was greater in DS than in DR (p less than 0.05). In both fat and heart, norepinephrine turnover was decreased by dietary NaCl loading in DR (p less than 0.01), but not in DS. Thus, the tendency of the DS to become hypertensive with high NaCl intake may be related to the combined effects of an increased plasma volume and the failure of high dietary NaCl to inhibit peripheral sympathetic nervous system activity.

Animals↗
PubMed1987

Control of renin release by dietary NaCl in the rat.

The purpose of the present study is to determine whether changes of plasma renin activity (PRA) induced by dietary NaCl are mediated by a renal tubular mechanism or by a neural mechanism. Male Sprague-Dawley rats were placed on low-, normal-, or high-NaCl diets for 1 wk (n = 8 for each group). There were no group differences of glomerular filtration rate (GFR), renal plasma flow, Na+ or Cl- delivery to the loop, Na+ or Cl- reabsorption in the loop, Na+ or Cl- concentration in early distal tubular fluid, or Na+ or Cl- delivery to the early distal tubule. PRA of rats on normal NaCl (4.8 ng.ml-1.h-1 +/- 0.8) was greater (P less than 0.05) than that of rats on high NaCl (3.3 +/- 0.4) and less (P less than 0.05) than that of animals on low NaCl (9.1 +/- 1.8). To determine whether alterations of PRA by dietary NaCl might be related to low-pressure baroreceptors with vagal afferents, animals were bilaterally vagotomized after micropuncture. Forty-five minutes after vagotomy, PRA increased (P less than 0.05) on each of the diets, however, after vagotomy mean PRA in animals fed normal (10.9 +/- 1.8) and low NaCl (13.2 +/- 2.2) did not differ. Thus our results do not support the hypothesis that suppression of PRA by dietary NaCl loading is related to a renal tubular mechanism. A vagally mediated mechanism may contribute to renin suppression by dietary NaCl.

Animals↗
PubMed1987

Multiple endocrine neoplasia type IIb: a description of several patients and review of the literature.

Our experience exemplifies the varied clinical presentations of patients with MEN IIb. This syndrome may be familial or sporadic, and clinical stigmata may be identifiable in infancy, particularly the characteristic facies and the appearance of ganglioneuromas. First-degree relatives of affected propositi and individuals with other stigmata of the syndrome should be screened carefully and repeatedly for both medullary thyroid carcinoma and pheochromocytoma. The availability of sensitive screening tests may permit detection of C-cell hyperplasia of the thyroid and adrenal medullary hyperplasia before the development of malignancy or hemodynamic consequences of pheochromocytoma. Early detection of these thyroid and adrenal disorders will permit early surgical intervention.

Adolescent↗
PubMed1987

Renal tubular chloride and renin release.

We have suggested that the renal tubular signal for renin release is related to alterations of sodium chloride cotransport in the TALH. Renin release is inhibited by increased sodium chloride transport and stimulated by interrupted sodium chloride transport. Because of the different affinities of the carriers for sodium and chloride, chloride rather than sodium is rate limiting for this cotransport process. Consequently, renin release is related to alterations of chloride delivery rather than sodium delivery to the TALH. The reduction of PRA by selective chloride loading and by short-term infusion of chloride salts is related to increased chloride delivery to the loop and hence increased chloride transport. Alternatively, chlorpropamide and antidiuretic hormone may inhibit renin release by increasing chloride delivery to the loop. Stimulation of renin release may likewise be related either to decreased chloride delivery and hence decreased transport in the loop (hypochloremia related to selective chloride deprivation) or to an intrinsic alteration in the transporting capacity of the loop (loop diuretics, potassium depletion, glucocorticoid deficiency, Bartter's syndrome). The intermediate steps between alterations of sodium chloride transport in the TALH and renin release remain to be defined.

Animals↗
PubMed1986

Impact of a rural high blood pressure control program on hypertension control and cardiovascular disease mortality.

Kentucky is a predominantly rural state with relatively high death rates from hypertension and cardiovascular disease. We report the results of a community-based high blood pressure control educational program undertaken in two rural counties of southeastern Kentucky. In the intervention counties, systolic and diastolic blood pressures of both men and women decreased despite the five-year increase in age; moreover, hypertension was better controlled after the program, and substantial decreases in deaths due to cardiovascular disease were seen. These differences were greater among men in the two regions than among women. The results of this program suggest that, in sparsely populated rural areas, existing resources and programs can be successfully utilized in a communitywide cardiovascular disease risk reduction educational program.

Adolescent↗
PubMed1986

Dissociation of hyperreninemia and renal prostaglandin synthesis in the adrenalectomized rat.

The aim of this study was to determine whether hyperreninemia in the adrenalectomized (ADX) rat is dependent on renal prostaglandin synthesis, as has been suggested for two other hyperreninemic conditions, Bartter's syndrome and chronic liver disease. Plasma renin concentration (PRC) in anesthetized, ADX rats was significantly increased (delta +480%; p less than 0.001) compared to sham-operated controls. In vivo, indomethacin (10 mg/kg i.v.) significantly reduced PRC of anesthetized, ADX rats after both 45 min (delta -34%; p less than 0.05) and 90 min (delta -47%; p less than 0.05). In vitro renin release from renal cortical slices of ADX rats was also significantly greater (delta +130%; p less than 0.05) than from sham-operated control cortical slices. Renin release from cortical slices of ADX rats given dexamethasone (10 micrograms/kg/day) for 4 days prior to sacrifice did not differ from sham-operated control values. Prostaglandin E2 (PGE2) release from cortical slices of ADX rats did not differ significantly from controls. However, PGE2 synthesis in glomeruli microdissected from ADX rats was significantly increased (delta +110%; p less than 0.001) compared to controls. PGE2 synthesis in glomeruli of dexamethasone-treated ADX rats remained significantly elevated compared to controls. Ibuprofen (10(-6) M) decreased PGE2 synthesis in cortical slices by 80%. However, prostaglandin synthesis inhibition had no effect on renin release from either ADX or control renal cortical slices. These results suggest that despite increased glomerular synthesis, prostaglandins do not directly influence renin release in the ADX rat.

Adrenalectomy↗
PubMed1986

Effects of chlorpropamide on loop of Henle function and plasma renin.

We have suggested that inhibition of renin release by sodium chloride is related to increased absorptive solute transport in the loop of Henle. In the rat, we have shown that reduced chloride transport in the loop is associated with increased renin release. Based on indirect evidence, it has been suggested that chlorpropamide (CPMD) increases loop solute transport. This study directly evaluates the effect of CPMD on loop chloride transport and plasma renin activity (PRA) in the male Sprague-Dawley rat. Loop of Henle chloride reabsorption (measured by recollection micropuncture) and PRA were determined before and after acute infusion of CPMD (N = 8) or vehicle (N = 8). Although delivery to the loop was not significantly changed, CPMD increased (P less than 0.05) absolute loop chloride reabsorption from 1798 pEq/min +/- 200 SE to 2453 pEq/min +/- 206 SE. PRA was decreased (P less than 0.01) from 9.2 ng/ml/hr +/- 1.0 SE to 5.6 ng/ml/hr +/- 0.8 SE following CPMD infusion. Comparable vehicle infusion did not alter loop chloride reabsorption or PRA. Arterial pressure, and whole kidney and single nephron glomerular filtration rates were unchanged following infusion of CPMD or vehicle. These results demonstrate that an increase in loop chloride reabsorption is associated with a decrease in renin release. This observation is consistent with the hypothesis that renin release is inversely related to the magnitude of chloride transport in the thick ascending limb of the loop of Henle.

Animals↗
PubMed1986

Effect of dietary chloride on salt-sensitive and renin-dependent hypertension.

We have previously reported that 1) selective dietary sodium loading (without chloride) does not produce hypertension in rats of the Dahl salt-sensitive strain (DS) and 2) selective chloride loading (without sodium) lowers plasma renin activity in the intact Sprague-Dawley rat maintained on a low NaCl diet. The present study examined the effect of selective dietary chloride loading on two models of hypertension: the DS and the renin-dependent one-kidney, one clip Sprague-Dawley rat. The DS were pair-fed (n = 7/group) a "normal" NaCl, a high NaCl (4%), or a "normal" sodium-high chloride diet for 11 weeks. From Week 7 until the end of the experiment, the high NaCl-fed animals had higher (p less than or equal to 0.05) blood pressures than animals fed either the normal NaCl or normal sodium-high chloride diet, which were not different from each other. Thus, in the DS, hypertension depends on high dietary intakes of both sodium and chloride. In one-kidney, one clip hypertensive rats, selective chloride loading failed to lower plasma renin activity (9 +/- 1 vs 7 +/- 1 ng angiotensin I/ml/hr) or to prevent hypertension (160 +/- 10 vs 166 +/- 9 mm Hg). Thus, selective dietary chloride loading (without sodium) does not alter blood pressure in either salt-sensitive or renin-dependent hypertension.

Animals↗
PubMed1986

Role of volume and prostaglandin synthesis in the suppression of renin by saline in the rat.

To evaluate the contribution of plasma volume expansion per se on acute inhibition of renin release by sodium chloride infusion, renin responses to comparable plasma volume expansion with intravenous infusions of sodium chloride, sodium bicarbonate, or albumin were studied in separate groups of sodium chloride-depleted rats. In addition, urinary prostaglandin E2 (PGE2) excretion rate was compared in the saline- and sodium bicarbonate-infused animals to evaluate the relationship between acute changes in renin release and intrarenal PGE2 synthesis. All three groups were plasma volume-expanded by approximately 55%. Plasma renin activity (PRA) decreased in response to saline (12.3 +/- 1.0 to 6.7 +/- 0.7 ng AI/ml/hr; P less than 0.01) whereas PRA did not change with sodium bicarbonate (11.3 +/- 1.4 to 10.2 +/- 1.5) or albumin (9.9 +/- 0.7 to 8.2 +/- 1.0). The rate of PGE2 excretion was not changed by either saline (72.2 +/- 13.1 to 72.3 +/- 18.7 pg/min) or sodium bicarbonate infusion (70.7 +/- 8.8 to 64.9 +/- 7.0). These results support the hypothesis that acute suppression of PRA by infusion of saline is not dependent upon volume expansion per se. In confirmation of earlier observations, inhibition of renin release by sodium chloride was related to chloride. Finally, the results suggest that the renal tubular mechanism for inhibition of renin release by sodium chloride is not related to overall changes in renal PGE2 synthesis in the rat.

Albumins↗
PubMed1985

Mechanism for inhibition of renin release by acute plasma volume expansion in the dog.

Plasma volume expansion alters renal tubular sodium chloride transport and renal nerve activity. The purpose of this study was to determine the mechanism(s) for inhibition of renin secretion by acute volume expansion with albumin in the anesthetized dog. In dogs with a single intact kidney, albumin infusion decreased renin release by 86% and significantly increased renal blood flow, glomerular filtration rate, and sodium excretion. Albumin volume expansion inhibited renin secretion to a lesser extent in dogs with denervated filtering kidneys and in dogs with innervated nonfiltering kidneys. In dogs with denervated nonfiltering kidneys, albumin infusion did not change renin secretion. Comparable volume expansion was produced in all groups. Thus, inhibition of renin release by acute plasma volume expansion is dependent on both a renal tubular mechanism and the integrity of the renal nerves. Partial inhibition of renin release was observed with interruption of either one of the mechanisms, whereas interruption of both mechanisms totally abolished the effect of acute plasma volume expansion on renin secretion.

Albumins↗