Active and inactive renin after captopril (SQ 14225) administration in hypertensive patients

The changes in active and inactive renin after oral administration of captopril (SQ 14225) were studied in 29 hypertensive patients. Inactive renin was calculated as plasma renin activity (PRA) after cold storage (total renin) minus PRA before cold storage (active renin). The patients were divided into 2 groups, responders and non-responders, according to the response of active renin to captopril. In 9 responders, the active renin increased markedly, while the inactive renin decreased. On the other hand, in 20 non-responders, both renin activities increased only slightly. Total renin increased markedly in responders; it increased in much smaller degree but significantly in non-responders. These data suggest that captopril promotes the conversion of inactive renin to active one and augments the renin release as a whole.     

The changes in active and inactive renin induced by various maneuvers in hypertensive patients

The changes in active and inactive renin after captopril (n = 29) or furosemide administration (n = 10) were studied in hypertensive patients. Furthermore, after percutaneous transluminal angioplasty (PTA) in 3 cases of renovascular hypertension (RVH), and after nephrectomy in a case of juxtaglomerular cell tumor, the time course of the changes in these two types of renin was investigated. Inactive renin was activated by trypsin treatment. Plasma renin concentration was measured by using an excess of sheep substrate. In patients with essential hypertension or primary aldosteronism, inactive renin was unchanged, irrespective of response in active renin, after the administration of captopril and furosemide. In patients with RVH, inactive renin was markedly decreased by furosemide but unchanged by captopril, in spite of significant increase in active renin. After PTA and nephrectomy, inactive renin decreased slower than active renin. These data support the idea that in patients with RVH, the increase in active renin by furosemide is at least partly due to the activation of inactive renin. It is also suggested that the increase in active renin by captopril is mainly due to the promoted release of active renin from the kidney. Furthermore, it seems likely that the metabolic clearance of inactive renin is slower than that in active renin.     

Active and inactive renin in normal human plasma. Comparison between acid activation and cryoactivation.

Inactive renin in human plasma is converted to active renin in vitro by acid activation or by cryoactivation. Renin activity was measured at pH 5.5 and renin concentration at pH 7.4. The plasma renin activity before and after cryo-treatment is termed active (APRA) and total (TPRA) plasma renin activity; the plasma renin concentration before and after acid treatment active (APRC) and total (TPRC) plasma renin concentration. In this study we demonstrated that in normal subjects the proportion of active to total renin after cryo-treatment averaged 61%, which was significantly (p less than 0.001) higher than the mean percentage active renin of 34 found with the acid activation procedure. Plasma angiotensin II correlated significantly with APRA, TPRA, TPRC and plasma angiotensin I (PA I), but not with inactive renin, which suggests that inactive renin does not produce angiotensin II in vivo. Cold treatment after acid activation and acid treatment after cryoactivation did not provoke a significant change in the measured renin concentration. Our data support the view that acidification of the plasma activates more than does cryo-treatment, and that inactive renin does not contribute to plasma angiotensin II.     

Response of serum total renin to ramipril and metoprolol in hypertensive patients

Renin-angiotensin system has long been thought to be a classic endocrine negative feedback system in the pathophysiology of hypertension. Furthermore, angiotensin II formation was believed to be regulated by renin secreted from the kidneys. In contrast to these considerations is the identification of local angiotensin II production in other tissues than pulmonary vasculature. Prorenin, the molecular precursor of renin, has been assumed to be involved in local angiotensin II production because of its renin-like activity. Prorenin has also been found to be secreted from extrarenal sources, although a major part of it is derived from the kidneys. Increased concentration of total renin in serum has been proposed to be useful in identifying patients with active proliferative retinopathy in insulin-dependent diabetic patients. Renin-angiotensin system is strongly affected by angiotensin-converting enzyme (ACE) inhibitors and therefore the interfering effect of ACE inhibitor medication on total renin concentration should be known in order to interpret serum total renin concentrations. Nine hypertensive outpatients, all men, treated at the department of internal medicine in Turku University Central Hospital, received randomly 5 mg of ramipril or 95 mg of metoprolol once a day for 4 weeks. Ramipril significantly increased the mean value of total renin (191.9 ng/l vs 312.0 ng/l, p<0.01), but the metoprolol-induced increase in the concentration of serum total renin was insignificant. We conclude that the negative feedback mechanism in regulating renin and prorenin secretion was inhibited by ACE inhibitor ramipril but beta1-selective adrenoceptor antagonist metoprolol did not significantly change total renin concentration in serum.     

Response of serum total renin to ramipril and metoprolol in hypertensive patients

Renin-angiotensin system has long been thought to be a classic endocrine negative feedback system in the pathophysiology of hypertension. Furthermore, angiotensin II formation was believed to be regulated by renin secreted from the kidneys. In contrast to these considerations is the identification of local angiotensin II production in other tissues than pulmonary vasculature. Prorenin, the molecular precursor of renin, has been assumed to be involved in local angiotensin II production because of its renin-like activity. Prorenin has also been found to be secreted from extrarenal sources, although a major part of it is derived from the kidneys. Increased concentration of total renin in serum has been proposed to be useful in identifying patients with active proliferative retinopathy in insulin-dependent diabetic patients. Renin-angiotensin system is strongly affected by angiotensin-converting enzyme (ACE) inhibitors and therefore the interfering effect of ACE inhibitor medication on total renin concentration should be known in order to interpret serum total renin concentrations. Nine hypertensive outpatients, all men, treated at the department of internal medicine in Turku University Central Hospital, received randomly 5 mg of ramipril or 95 mg of metoprolol once a day for 4 weeks. Ramipril significantly increased the mean value of total renin (191.9 ng/l vs 312.0 ng/l, p < 0.01), but the metoprolol-induced increase in the concentration of serum total renin was insignificant. We conclude that the negative feedback mechanism in regulating renin and prorenin secretion was inhibited by ACE inhibitor ramipril but beta 1-selective adrenoceptor antagonist metoprolol did not significantly change total renin concentration in serum.     

Activation of inactive plasma renin by plasma and tissue kallikreins.

1. Normal human plasma contains a proactivator of inactive renin. The pro-activator is activated at physiological pH in plasma that has been pretreated with acid. This activation in vitro leads to the conversion of inactive renin into the active form with simultaneous generation of kallikrein activity. 2. The endogenous activator of inactive renin has the same pH profile and inhibitor spectrum as plasma kallikrein. 3. Inactive renin can also be activated by exposure of plasma to exogenous trypsin, and in normal plasma the quantities of inactive renin that are activated after acidification and with trypsin are identical. Prekallikrein (Fletcher factor)-deficient plasma, however, has much lower renin activity after acidification than with trypsin. Thus acid activation of inactive renin depends on plasma prekallikrein, whereas the action of trypsin is independent of prekallikrein. 4. Highly purified tissue (pancreatic) kallikrein, in a concentration of less than 2 X 10(-8) mol/l, activates inactive renin that has been isolated from plasma by ion-exchange chromatography. In this respect it is at least 100 times more potent than trypsin. 5. It is therefore possible that plasma and/or tissue (renal) kallikreins are also involved in the activation of inactive renin in vivo.     

Characterization of inactive renin from human kidney and plasma. Evidence of a renal source of circulating inactive renin.

An inactive form of renin has been isolated from human plasma. It has been suggested that this may represent renin precursor secreted from the kidney. However, early studies failed to isolate inactive renin from human renal tissue. In this investigation, rapid processing of human kidney cortex at temperatures below 4 degrees C in the presence of protease inhibitors followed by cibacron-blue affinity chromatography allowed us to extract a totally inactive form of renal renin. Furthermore, we found that in kidney inactive renin constituted from 10 to as much as 50% of the total renin concentration. Biochemical characterization of the inactive renin from plasma and from kidney indicates that they are structural homologues and, when activated, have enzymatic properties that resemble active renal renin. Renal and plasma inactive renin were found to have the following properties in common: (a) a pH optimum of activation of 3.3; (b) reversible activation by acid dialysis on return to pH 7.4, 37 degrees C; (c) pH optima of enzyme activity of 7.8 with sheep angiotensinogen and 5.5 and 6.7 (biphasic) with human angiotensinogen; (d) Michaelis-Menten constants, Km, of 0.29-0.34 microM with sheep angiotensinogen, and 0.99-1.25 microM with human angiotensinogen; (e) an antibody to human renal renin mean inhibitory titer of 1:30,000 with 1 X 10(-4) Goldblatt units of activated renal or plasma inactive renin; (f) gel filtration profiles consisting of two peaks with apparent molecular weights of 56,000 +/- 1,500 and 49,200 +/- 1,000. Activation of plasma and kidney inactive renin by acid plus renal kallikrein was not accompanied by a change in gel filtration elution patterns. To determine whether inactive renin is released by the kidney, we measured inactive renin in samples obtained simultaneously from both the renal veins and inferior vena cava below the origin of the renal veins. In eight consecutive patients, inactive renin concentration was significantly higher in renal venous blood than in inferior vena caval blood. These data indicate that human kidney contains and secretes significant quantities of inactive renin. Thus, the kidney appears to be a major source of inactive renin in human plasma.     

The nature of inactive renin in human plasma and amniotic fluid.

1. The properties of inactive and active renin in human plasma and amniotic fluid were studied chromatographically. Activation was achieved at pH 3.3 with and without added pepsin. 2. Acid activation of renin was time- and temperature-dependent but was inhibited by dilution of the sample. The dilution effect was corrected by adding pepsin. Such characteristics indicate that activation at low pH is catalysed by intrinsic enzymes. 3. Separation and/or dilution of the activating enzyme during ion-exchange chromatography concealed the eluted position of inactive renin and reduced the amount recovered. Only after full activation of the eluted renin was achieved with added pepsin was a distinct peak of inactive renin exposed. 4. At pH 7.5 inactive renin carried a lower negative charge than the active enzyme. This charge difference was lost after activation. 5. No molecular-weight differences between active, inactive renin or the International Renin Standard were detected by gel filtration. No renin of larger molecular weight was present. 6. These findings will be helpful in purification studies of human inactive renin.     

原发性高血压患者血浆色氨酸、犬尿氨酸和犬尿喹啉酸浓度的变化

目的通过测定血浆色氨酸(TRP)、犬尿氨酸(KYN)和犬尿喹啉酸(KYNA)浓度,探讨外周吲哚胺2,3-双加氧酶(IDO)和犬尿氨酸氨基转移酶(KAT)活性与原发性高血压(EH)的关系。方法采用高效液相色谱法(HPLC)测定100例EH患者和80名健康体检者(对照组)血浆TRP、KYN和KYNA浓度,计算产物/底物的百分比来评价酶活性,即IDO活性=KYN/TRP×100%,KAT活性=KYNA/KYN×100%。结果 EH组血浆TRP浓度为(59.85±9.89)μmol/L,明显高于对照组[(48.19±7.72)μmol/L,P<0.001];KYN浓度为(2.01±0.48)μmol/L,明显低于对照组[(2.17±0.43)μmol/L,P<0.05]。EH组和对照组血浆KYNA浓度分别为(24.10±9.12)、(23.59±7.27)μmol/L,二者差异无统计学意义(P>0.05)。EH组IDO活性为3.40%±0.85%,明显低于对照组(4.54%±0.81%,P<0.001);而KAT活性为1.20%±0.36%,明显高于对照组(1.09%±0.27%,P<0.05)。EH组血浆TRP浓度与年龄呈负相关(r=-0.316,P=0.001),而对照组二者之间无明显相关性(r=-0.208,P=0.064)。EH组和对照组血浆IDO活性均与年龄呈正相关(EH组:r=0.264,P=0.008;对照组:r=0.305,P=0.006)。2组血浆KYN、KYNA浓度及KAT活性与年龄均无明显相关性。结论EH组血浆TRP浓度明显增高而KYN浓度明显降低,提示外周TRP-KYN代谢途径的IDO活性可能与EH有关。     

高血压性心脏病患者血浆脂联素水平的变化

目的探讨高血压性心脏病患者血浆脂联素水平的变化,为早期预防高血压心脏靶器官损害提供理论依据。方法选择2007年10月至2008年5月在徐州市中心医院门诊或心内科住院的55例原发性高血压患者,分为两组：高血压组30例,高血压心脏病组25例。对照组为同期该院体检中心健康体健者40例。采用酶联免疫吸附法测定血浆脂联素含量。结果血浆脂联索：高血压组（1050±310）ng／ml显著低于正常组（2050±450）ng/ml（P〈0．01）,高血压心脏病组（650±136）ng／ml显著低于高血压组（P〈0．01）与正常组（P〈0．01）。结论血浆脂联素水平的变化与原发性高血压的病情程度密切相关。     

Effects of metoprolol on blood pressure and plasma renin activity in thiazide-resistant hypertensive patients.

Twenty patients with mild to moderate hypertension whose blood pressures were not adequately controlled by a thiazide diuretic were treated for 4 wk with metropolol. Normotension (diastolic pressure less than 90 mm Hg) or reduction in diastolic pressure of at least 10 mm Hg was achieved in 12 of the patients 1 wk after metoprolol (200 mg/day) was added to the hydrochlorothiazide (100 mg/day) regimen. In the other 8 patients, pressure reduction was attained with larger doses (300 to 400 mg/day) of metoprolol. After 1 wk of combined therapy, heart rate decreased by 11% (p less than 0.001) and plasma renin activity (PRA) decreased 48% (p less than 0.001). The individual changes in mean blood pressure did not correlate with either the premetoprolol PRA level (r = 0.14) or the changes in PRA after metoprolol (r = 0.03) but did correlate with steady-state metoprolol plasma levels (r = 0.61, p less than 0.01). Pressure and heart rate reductions were sustained during the last 3 wk of combined therapy but the PRA decrease did not persist; levels gradually rose to near control by the fourth week. Urinary sodium excretion was not consistently changed on metoprolol therapy.     

Characterization of inactive renin ("prorenin") from renin-secreting tumors of nonrenal origin. Similarity to inactive renin from kidney and normal plasma

Inactive renin comprises well over half the total renin in normal human plasma. There is a direct relationship between active and inactive renin levels in normal and hypertensive populations, but the proportion of inactive renin varies inversely with the active renin level; as much as 98% of plasma renin is inactive in patients with low renin, whereas the proportion is consistently lower (usually 20-60%) in high-renin states. Two hypertensive patients with proven renin-secreting carcinomas of non-renal origin (pancreas and ovary) had high plasma active renin (119 and 138 ng/h per ml) and the highest inactive renin levels we have ever observed (5,200 and 14,300 ng/h per ml; normal range 3-50). The proportion of inactive renin (98-99%) far exceeded that found in other patients with high active renin levels. A third hypertensive patient with a probable renin-secreting ovarian carcinoma exhibited a similar pattern. Inactive renins isolated from plasma and tumors of these patients were biochemically similar to semipurified inactive renins from normal plasma or cadaver kidney. All were bound by Cibacron Blue-agarose, were not retained by pepstatin-Sepharose, and had greater apparent molecular weights (Mr) than the corresponding active forms. Plasma and tumor inactive renins from the three patients were similar in size (Mr 52,000-54,000), whereas normal plasma inactive renin had a slightly larger Mr than that from kidney (56,000 vs. 50,000). Inactive renin from each source was activated irreversibly by trypsin and reversibly by dialysis to pH 3.3 at 4 degrees C; the reversal process followed the kinetics of a first-order reaction in each instance. The trypsin-activated inactive renins were all identical to semipurified active renal renin in terms of pH optimum (pH 5.5-6.0) and kinetics with homologous angiotensinogen (Michaelis constants, 0.8-1.3 microM) and inhibition by pepstatin or by serial dilutions of renin-specific antibody. These results indicate that a markedly elevated plasma inactive renin level distinguishes patients with ectopic renin production from other high-renin hypertensive states. The co-production of inactive and active renin by extrarenal neoplasms provides strong presumptive evidence that inactive renin is a biosynthetic precursor of active renin. The unusually high proportion of inactive renin in plasma and tumor extracts from such patients is consistent with ineffective precursor processing by neoplastic tissue, suggesting that if activation of "prorenin" is involved in the normal regulation of active renin levels it more likely occurs in the tissue of origin (e.g., kidney) than in the circulation.     

The basal levels of active and inactive plasma renin concentration in infancy and childhood

Basal plasma renin activity, active and inactive plasma renin concentration were measured in 89 healthy recumbent children aged between 1 week and 16 years. A significant (P less than 0.001) age-related decrease for active (r = -0.60), inactive (r = -0.59) and total renin concentration (r = -0.66) was observed. After correction for the influence of age, active renin concentration correlated with plasma renin activity (r = 0.81), but not with inactive renin concentration (r = 0.18). The proportions of active and inactive renin were not related to age, and the overall percentage of inactive renin was 79%.     

Two different types of inactive renin in human plasma: molecular and kinetic properties

We separated inactive renin in human plasma into two types, adsorbed and non-adsorbed, by chromatography on a concanavalin A-Sepharose column. About 75% of fresh plasma inactive renin was adsorbed to the column, and the rest passed through it. Non-adsorbed and adsorbed inactive renins were partially purified. Non-adsorbed inactive renin had a molecular weight of 48000 and an isoelectric point of 5.44. Adsorbed inactive renin had a molecular weight of 46000 and isoelectric points of 5.56 and 5.80. After activation with trypsin, both activated inactive renins were similar with respect to molecular weight (45000), thermostability, Km value (0.56 mumol/l) and pH profile. But pI values of both activated inactive renins differed. These results indicate that there exist in human plasma two different types of inactive renin which differ in carbohydrate composition.     

The effect of captopril on catecholamines, renin activity, angiotensin II and aldosterone in plasma during physical exercise in hypertensive patients

Abstract. The studies were designed to explore the effect of the converting enzyme inhibitor captopril on the activity of the sympathetic nervous system during basal conditions and following graded physical exercise in patients with essential hypertension. Seven males and two females, aged 36–59 years, were hospitalized under metabolic ward conditions and treated for 7 days with captopril given orally in increasing dosages, the final dose being 600 mg daily. The patients were subjected to an individual, graded submaximal work test (bicycling) for 20 min before medication and then again in an identical manner during medication with 600 mg captopril. Blood samples were drawn before exercise and then after 10 and 20 min of work for the determination of plasma angiotensin II (PA II), plasma aldosterone (PAC), plasma renin activity (PRA), plasma noradrenaline (PNA) and plasma adrenaline (PA). Before medication blood pressure (mmHg) was 195/133 immediately before exercise, 230/129 after 10 min of moderate exercise and 263/105 following 20 min of nearly maximal work. During treatment with captopril the respective blood pressure values were 154/110, 200/100 and 245/98. Captopril had no significant effect on the changes in heart rate following physical exercise. PA II and PAC were substantially reduced and PRA considerably increased by captopril. PA II, PAC and PRA increased in response to exercise both before and following captopril. The exercise stimulated increase in PNA and PA was almost identical before and during captopril. Thus, captopril had no major effect on the activity of the sympathetic nervous system in patients with essential hypertension, neither during basic conditions nor during heavy physical exercise in spite of a profound decrease in PA II.     

The effect of tyramine, noradrenaline, and angiotensin on the blood pressure in hypertensive patients with aldosteronism and low plasma renin

Abstract The reactivity to the pressor action of tyramine, noradrenaline, and angiotensin was determined in 9 patients with hypertension, aldosteronism and low plasma renin concentration (4 patients with solitary adrenal adenomas, 3 patients with nodular adrenal hyperplasia, 2 patients with unknown adrenal status). In 7 patients tests were repeated following unilateral or subtotal adrenalectomy respectively. For comparison, 5 patients with phaeochromocytoma, 10 patients with benign essential hypertension, and 12 normotensive control subjects were studied. — In the hypertensive patients with aldosteronism and low plasma renin, responsiveness to tyramine was significantly reduced. In contrast, pressor response to noradrenaline was in the normal range, and sensitivity to angiotensin was increased. Following adrenal surgery, sensitivity to tyramine increased in all cases but one, sensitivity to noradrenaline did not change significantly, and responsiveness to angiotensin decreased in all cases but one. — It is discussed that the reduced pressor effect of tyramine in the hypertensive patients with aldosteronism is due to a disturbance of adrenergic function which may be of importance for the diminished production of renin in these forms of hypertension.     

Cyclic AMP, renal function and dihydralazine-stimulated renin secretion in hypertensive patients.

The concentrations of plasma cAMP and plasma renin activity were determined in arterial and renal venous plasma in nineteen patients investigated for renin-mediated hypertension. The cAMP measurements were performed in two different situations (1) under basal conditions and (2) after i.v. dihydralazine administration, a potent renin stimulation procedure. Thirteen patients had a lateralization of the renin secretion in the basal state and the administration of dihydralazine caused a further marked renin-secretion. The cAMP concentration was higher in the renal veins draining renin-positive kidneys than in the contralateral renal veins. No significant change was observed between the arterial cAMP concentration and the cAMP concentration in either of the renal veins during dihydralazine-stimulated renin secretion. There was no correlation between the cAMP extraction and the renin secretion of the individual kidneys, but the cAMP extraction correlated with the extraction ratio of PAH. These results show that cAMP values are mainly influenced by the renal function and are not related to the state of renin secretion. Increased cAMP levels in renovascular patients and urameic patients are therefore mainly due to defective elimination of the nucleotide by the kidneys.