| For medical practitioners and the general public - High Blood Pressure Journal Article Catalog. |
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| Loss of diurnal rhythms of blood pressure and heart rate due to high fat feeding Kaneda, R. and K. Kario (2005), Am J Hypertens 18(10): 1327-8. |
| Louisiana high blood pressure control program Huber, M. L., L. Lambert, et al. (1984), J La State Med Soc 136(5): 11-3. |
| Low and high frequency components of blood pressure variability Pagani, M., D. Lucini, et al. (1996), Ann N Y Acad Sci 783: 10-23. |
| Low birth weight and risk of high blood pressure in adulthood Gennser, G., P. Rymark, et al. (1988), Br Med J (Clin Res Ed) 296(6635): 1498-500. Abstract: Hospital birth records were sought for 104 men from a pool of male army conscripts with "normal" or "high" blood pressure when measured at 28 years of age. Of 77 men whose birth weight and date of the mother's last menstrual period before the pregnancy could be found, 25 had a resting diastolic blood pressure of greater than or equal to 90 mm Hg. In 11 of these compared with nine of the 52 men with normal diastolic pressures their birth weights in relation to gestational age had been below the mean and 1 SD of a comparable Swedish population. The risk of increased diastolic blood pressure in early adult life was significantly higher among men who had been growth retarded at birth than among those whose birth weight had been appropriate for gestational age (odds ratio 3.63; 95% confidence interval 1.14 to 12.57). Being born small for gestational age may be a predictor of raised blood pressure in early adult life. |
| Low mineral intake is associated with high systolic blood pressure in the Third and Fourth National Health and Nutrition Examination Surveys: could we all be right? Townsend, M. S., V. L. Fulgoni, 3rd, et al. (2005), Am J Hypertens 18(2 Pt 1): 261-9. Abstract: Analysis of the first National Health and Nutrition Examination Survey (NHANES) in 1984 revealed that a dietary pattern low in mineral intake, specifically calcium, potassium, and magnesium, was associated with hypertension in American adults. Using more recent survey data from NHANES III and NHANES IV, we re-examined the validity of this relationship. Blood pressure (BP) and nutrient intake data from 10,033 adult participants in NHANES III and 2311 adults in NHANES IV revealed findings similar to those of the earlier analysis, demonstrating that the association between inadequate mineral consumption and higher BP is valid and has persisted over two decades. Exploring this relationship further, we separated untreated hypertensive persons by hypertension type (systolic, diastolic, or both), and observed that the BP effect of low mineral intake was most pronounced in those with only systolic hypertension. We also observed that sodium intake was significantly lower in the systolic hypertension group and significantly higher in the diastolic hypertension group compared with the other groups. The nutrient pattern in the combined hypertension group was similar to that of the normotensive group. These findings may help to explain the inconsistent responses generally observed in dietary intervention studies, and they highlight the possible importance of tailored nutritional recommendations for hypertension based on hypertension category and individual dietary practices. Although randomized controlled trials are needed to characterize further the relationship between nutrient intake and hypertension type, these findings indicate that dietary management of hypertension may be more effective if the focus is on the overall nutritional profile rather than single-nutrient intake as currently recommended for most patients. |
| Lower esophageal sphincter pressure in patients with achalasia. Is high blood pressure frequent in these patients? Male Velasquez, R., C. Alvarez, et al. (2003), Rev Gastroenterol Mex 68(4): 258-60. Abstract: OBJECTIVE: To describe variability of lower esophageal sphincter (LES) pressure in patients with diagnosis of achalasia based in esophageal manometry. METHODS: We included 29 patients with diagnosis of achalasia confirmed by water perfusion manometry performed between July 2000 and June 2002 at the Digestive and Liver Disease Center in Guadalajara, Jalisco. Three were excluded due to impossibility of evaluating LES. RESULTS: Esophageal aperistalsis was found in all patients. LES pressure was normal in 73%, low (hypotension) in 8%, and high (hypertension) in only 19% of patients. Relaxation of LES showed different responses ranging from absence to complete relaxation after degluttion. There was absence of relaxation after degluttion in all patients with LES hypertension and hypotension. CONCLUSION: Hypertension of LES in our cohort of patients with achalasia was seen only in 19%. Knowledgement of manometric variability is fundamental to avoid errors in achalasia diagnosis and further patient treatment. |
| Lowering high blood pressure--to what extent? Meisel, S. and T. Rosenthal (1989), Harefuah 116(5): 290-2. |
| Management guidelines for optometric screening for high blood pressure Eisenberg, S., J. Posner, et al. (1978), J Am Optom Assoc 49(6): 685-91. |
| Management of adrenal incidentaloma combined with high blood pressure Mathonnet, M. (2005), Ann Chir 130(5): 303-8. Abstract: Hypertension (HTA) is a very common disease but its origin is well known only in 1 to 5% of the cases. HTA is present in half of the patients who have an adrenal incidentaloma. Clinical data, hormonal sampling, computed tomography and adrenal scintigraphies are necessary to identify hyperfunctioning adrenal tumors. Adrenalectomy is indicated in case of potential malignant tumors and hyperfunctioning tumors. If HTA seems to be not in relation with the adrenal mass, it is recommended to recognize a congenital enzymatic block in order to ovoid an unnecessary adrenalectomy and to search for a preclinical Cushing's syndrome. The last one is associated with HTA in 91% of the cases, and with a morbid obesity, mellitus diabetes or dyslipidemia in 50% of the cases. The removal of the adrenal mass improves the HTA for half of the patients. If the adrenocortical tumor is nonfunctioning, patients have to be followed during a long time. HTA will be considered as "essential" after a new comprehensive analysis performed 3 years later. |
| Management of high blood pressure and cardiac insufficiency. New drugs and therapeutic concepts Schafer, S. and A. E. Busch (2003), Pharm Unserer Zeit 32(1): 54-9. |
| Management of high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks Douglas, J. G., G. L. Bakris, et al. (2003), Arch Intern Med 163(5): 525-41. |
| Management of high blood pressure in diabetes mellitus: lessons from The ADA Recommendation Waspadji, S. (2004), Acta Med Indones 36(1): 31-5. |
| Management of high blood pressure in general practice O'Hanrahan, M., M. Laher, et al. (1982), Ir Med J 75(4): 102-5. |
| Management of high blood pressure using beta-sympatholytics. Review Michel, D. (1976), Fortschr Med 94(32): 1826-32, 1858. |
| Management of high casual blood pressure in a disaster situation: the 1995 Hanshin-Awaji earthquake Kario, K. (1998), Am J Hypertens 11(9): 1138-9. |
| Managing hypertension in the southeastern United States: applying the guidelines from the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) Jones, D., J. Basile, et al. (1999), Am J Med Sci 318(6): 357-64. Abstract: The southeastern United States has the highest occurrence of heart disease and stroke and among the highest rates of congestive heart failure and renal failure in the country. The Consortium for Southeastern Hypertension Control (COSEHC) is cooperating with other organizations in implementing initiatives to reduce morbidity and mortality from hypertension-related conditions in the southeastern United States. This article outlines for clinicians special consideration for implementation of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) in the southeastern United States. Clinicians are encouraged to adapt the recommendations of JNC VI to their own patient groups, paying attention to these specific areas: (1) Ensure screening for hypertension in your practice and community. (2) Evaluate all patients for accompanying risk factors and target organ damage. (3) Promote lifestyle management for individual patients and populations for prevention and treatment of hypertension. (4) Set a goal blood pressure for each patient, and monitor progress toward that goal. (5) Recognize that many patients will be candidates for blood pressure goals of <130/85 mm Hg. (6) Pay attention to compelling and special indications such as diabetes, congestive heart failure, and renal dysfunction. (7) Consider combination therapy. (8) Maximize staff contributions to enhance patient adherence. (9) Encourage patient, family, and community activities to promote healthy lifestyles and blood pressure control. |
| Managing worry, stress and high blood pressure: African-American women holding it together through 'family' Boutain, D. M. (2001), Ethn Dis 11(4): 773-8. Abstract: Strategies to manage worry, stress and high blood pressure (HBP) are little understood from the perspective of African Americans. Using data from a qualitative research study in south Louisiana, this article outlines how participants with HBP managed worry and stress through the formation of family. In an exploration of 314 conversations about 'family,' African-American women were cited by both women and men as mediators of worry, stress, and HBP. Participants did not necessarily define 'family' by blood or marriage relations, unlike the way in which 'family' is presented in most HBP research. 'Family' was often discussed in terms of how relationships with others were utilized to share knowledge about HBP, to address situations that produced HBP elevation, and to marshal resources to manage HBP. |
| Mapping of the rat SM22 gene to chromosome 8q24: a candidate for high blood pressure and cardiac hypertrophy Koike, G., J. M. Miano, et al. (1998), Mamm Genome 9(1): 76-7. |
| Maternal environment and development of high blood pressure in Dahl hypertensive rats Murphy, C. A. and R. McCarty (1989), Am J Physiol 257(5 Pt 2): H1396-401. Abstract: The contribution of the preweanling maternal environment to the development of hypertension was examined using the technique of reciprocal cross-fostering between two inbred rat strains, the Dahl hypertension-sensitive (SS/Jr) rat and the Dahl hypertension-resistant (SR/Jr) rat. Litters of SS/Jr and SR/Jr pups were reared by their natural mother, in-fostered to a dam of the same strain, or cross-fostered to a dam of the opposite strain for the entire preweanling period from postnatal days 1 to 30. At 60 and 100 days of age, one rat from each litter was surgically prepared with an indwelling catheter in the ventral tail artery. One day after surgery, measures of resting mean arterial pressure and heart rate were taken as the animals were resting and undisturbed in their home cages. Body weights were also obtained at 30, 60, and 100 days of age as a measure of general somatic development. Our findings indicate that SS/Jr rats fostered to SR/Jr dams exhibited a significant reduction in resting mean arterial pressure compared with naturally reared or in-fostered SS/Jr rats (P less than 0.01 at 60 days and P less than 0.03 at 100 days). Conversely, arterial pressure of SR/Jr rats did not differ across rearing conditions at either age. Body weights were not significantly affected by cross-fostering in either strain. We conclude from these results that characteristics of the SS/Jr maternal environment interact with the inbred genetic susceptibility of the SS/Jr pup to elicit the full expression of the SS/Jr hypertensive phenotype. |
| Maternal hypertension during pregnancy and high blood pressure in children. Preliminary communication Svensson, A., L. Sigstrom, et al. (1983), Clin Exp Hypertens B 2(2): 203-9. Abstract: A group of 29 women with previous pre-eclampsia/hypertension in pregnancy and 37 of their children were investigated. At follow-up 7-12 years later, all mothers had mild to moderate hypertension. The children had a significantly higher blood pressure than age and sex-matched controls. Intracellular Na+ in erythrocytes from the children was normal but potassium was significantly higher compared to normotensive controls. The history of maternal essential hypertension and previous pre-eclampsia/hypertension in pregnancy seems to indicate an increased risk for high blood pressure in children, evident before puberty. |
| Measurement of tafenoquine (WR 238605) in human plasma and venous and capillary blood by high-pressure liquid chromatography Kocisko, D. A., D. S. Walsh, et al. (2000), Ther Drug Monit 22(2): 184-9. Abstract: A simple, rapid, and accurate high-pressure liquid chromatographic method with fluorescence detection is described for the measurement of tafenoquine (TQ) (also known as WR 238605) from human plasma and venous and capillary blood. Tafenoquine was measured in plasma and venous blood following protein precipitation. Chromatographic separation was achieved using a Waters S5P Spherisorb phenyl analytical cartridge (150 mm x 4.6 mm I.D., 5 microm particle size) (Waters, Milford, MA, USA) and a mobile phase of 22 mM ammonium acetate, pH 4:acetonitrile (45:55, vol/vol). The flow rate was 1.5 mL/min and the retention times were approximately 3.5 min for WR VIIIAc (internal standard) and approximately 7.8 min for TQ. The interday and intraday coefficients of variation of TQ over a concentration range of 20-1000 ng/mL in plasma were < or =8.4% and in venous blood were < or =9.6%. The mean percent difference between added concentration and obtained concentration was 7.3% in plasma and 8.5% in venous blood over the corresponding concentration range. The limit of quantitation for both fluids was 10 ng/mL. Tafenoquine concentrations were comparable between capillary and venous blood with no significant difference between measurement in both biological fluids. The clinical application of the method was demonstrated by measuring plasma and whole blood concentrations of TQ from participants in a chemosuppression trial of the drug against malaria infections in Thailand. |
| Measures for improving tolerance of multi stage cancer therapy; the duplication of O2 partial pressure in inspiratory air effects a significant increase of heart-blood circulation-reserves in hyperthermia of fever with high temperature-time-dosage von Ardenne, M. and H. G. Lippmann (1970), Dtsch Gesundheitsw 25(36): 1685-92. |
| Mechanisms contributing to high blood pressure Frohlich, E. D. (1983), Ann Intern Med 98(5 Pt 2): 709-14. Abstract: Essential hypertension, a disease that affects about 60 million Americans, is not a homogeneous clinical entity. The disease is caused by altered regulation of mechanisms that control arterial pressure. Because the manifestations of the abnormally regulated pressure have many factors, the approaches to treatment likewise may be expected to be multifactorial. Hemodynamic, neural and catecholamine, renopressor, renal excretory and volume, hormonal, electrolyte, and depressor mechanisms are discussed. Associated conditions that must be considered include exogenous obesity, hyperuricemia, coronary artery disease, carbohydrate intolerance, and hyperlipidemia. Clearer understanding of the role of each of these factors in essential hypertension should provide a rationale for wise selection of antihypertensive therapy and allow reversal of the very high rates of cardiovascular morbidity and mortality associated with the disease. |
| Mechanisms in obesity-related high blood pressure Dustan, H. P. (1984), Ala J Med Sci 21(1): 18-20. |
| Mechanisms of blood pressure regulation that differ in men repeatedly exposed to high-G acceleration Convertino, V. A. (2001), Am J Physiol Regul Integr Comp Physiol 280(4): R947-58. Abstract: The purpose of this study was to test the hypothesis that repeated exposure to high acceleration (G) would be associated with enhanced functions of specific mechanisms of blood pressure regulation. We measured heart rate (HR), stroke volume (SV), cardiac output, mean arterial blood pressure, central venous pressure, forearm and leg vascular resistance, catecholamines, and changes in leg volume (%DeltaLV) during various protocols of lower body negative pressure (LBNP), carotid stimulation, and infusions of adrenoreceptor agonists in 10 males after three training sessions on different days over a period of 5-7 days using a human centrifuge (G trained). These responses were compared with the same measurements in 10 males who were matched for height, weight, and fitness but did not undergo G training (controls). Compared with the control group, G-trained subjects demonstrated greater R-R interval response to equal carotid baroreceptor stimulation (7.3 +/- 1.2 vs. 3.9 +/- 0.4 ms/mmHg, P = 0.02), less vasoconstriction to equal low-pressure baroreceptor stimulation (-1.4 +/- 0.2 vs. -2.6 +/- 0.3 U/mmHg, P = 0.01), and higher HR (-1.2 +/- 0.2 vs. -0.5 +/- 0.1 beats. min(-1). mmHg(-1), P = 0.01) and alpha-adrenoreceptor response (32.8 +/- 3.4 vs. 19.5 +/- 4.7 U/mmHg, P = 0.04) to equal dose of phenylephrine. During graded LBNP, G-trained subjects had less decline in and SV, %DeltaLV, and elevation in thoracic impedance. G-trained subjects also had greater total blood (6,497 +/- 496 vs. 5,438 +/- 228 ml, P = 0.07) and erythrocyte (3,110 +/- 364 vs. 2,310 +/- 96 ml, P = 0.06) volumes. These results support the hypothesis that exposure to repeated high G is associated with increased capacities of mechanisms that underlie blood pressure regulation. |
| Medications for type-2 diabetes and high blood pressure Schroder, H. (2002), Med Monatsschr Pharm 25(11): 386-8. |
| Meeting the National Service Framework for coronary heart disease: which patients have untreated high blood pressure? Marshall, T. and A. Rouse (2001), Br J Gen Pract 51(468): 571-4. Abstract: BACKGROUND: The National Service Framework for coronary heart disease requires primary care teams to identify patients who are at high risk of cardiovascular events and treat those with high blood pressure. However, there are no data on how many must be assessed, how much cardiovascular disease can be prevented or which patients are most likely to benefit. AIM: To estimate the potential number of patients who are eligible for blood pressure assessment, the number of preventable cardiovascular disease events and the relative efficiency of the strategy in different age groups. DESIGN OF STUDY: Modelling exercise. SETTING: Hypothetical population of 100,000. METHOD: The age-sex specific prevalence of cardiovascular risk factors and of current anti-hypertensive treatment were obtained from published sources and combined with published estimates of the effectiveness of anti-hypertensive treatment. From these data were calculated numbers of persons eligible for assessment and treatment, and numbers of preventable cardiovascular events. RESULTS: There were 79,607 persons eligible for assessment and 5888 eligible for treatment. Treatment could prevent between 101 and 139 cardiovascular events annually. There were 11,571 persons aged over 65 years and eligible for assessment and 4655 eligible for treatment. Treatment could prevent 85 to 117 cardiovascular events annually. No cardiovascular events are prevented in persons aged under 45 years. CONCLUSION: Confining assessment to the 16% who are aged over 65 years prevents 85% of the population's avoidable cardiovascular disease. Primary care teams should assess and treat persons aged over 65 years before assessing younger patients. No health benefit results from assessing persons aged under 45 years. |
| Melting point, volume and stability of blood under high pressure Kluge, A. and H. Lentz (1987), Z Naturforsch C 42(11-12): 1370-2. Abstract: The melting pressure and the specific volume of human blood was measured up to pressures of 1000 bar or more. The melting pressure curve has a slope of -138 bar K-1. The compressibility of blood is nearly twice the value of blood serum. After application of high pressure the blood exhibits some haemolysis most probably due to the effect of the steel surface of the autoclave. |
| Mental and social factors in the development of high blood pressure Pflanz, M. (1974), Internist (Berl) 15(3): 124-8. |
| Mercury sphygmomanometers should not be abandoned: An advisory statement from the Council for High Blood Pressure Research, American Heart Association Jones, D. W., E. D. Frohlich, et al. (2001), Hypertension 37(2): 185-6. |
| Merits of reducing high blood-pressure Leishman, A. W. (1963), Lancet 1: 1284-8. |
| Metabolic syndrome and insulin resistance in the TROPHY sub-study: contrasting views in patients with high-normal blood pressure Egan, B. M., V. Papademetriou, et al. (2005), Am J Hypertens 18(1): 3-12. Abstract: BACKGROUND: Although insulin resistance and metabolic syndrome are often used synonymously, concordance is not established. METHODS: Metabolic, hemodynamic, and hormonal data were analyzed on 141 patients in the Trial of Preventing Hypertension (TROPHY) Sub-Study with high-normal blood pressure (BP) (130 to 139/85 to 89 mm Hg mean +/- SD, 133 +/- 8/85 +/- 6 mm Hg; age, 48 +/- 9 years; body mass index 30 +/- 5 kg/m(2)). RESULTS: Fifty-three of 141 subjects (37.6%; approximately 3/8) had the metabolic syndrome based on three or more of the five risk factors (BP, waist circumference, fasting triglycerides, HDL-cholesterol, glucose). To maintain consistency in proportions, insulin resistance was defined as the upper 3/8 of the distribution on the homeostatic model assessment (HOMA), which uses fasting glucose and insulin and a modified Matsuda-DeFronzo index, based on fasting, 1- and 2-h glucose and insulin values. Among metabolic syndrome patients, 57% and 55% were in the upper 3/8 of the distribution for insulin resistance by HOMA and Matsuda-DeFronzo, respectively. Among subjects without the metabolic syndrome, 26% and 27% were insulin resistant by HOMA and Matsuda-DeFronzo criteria. The proportion of patients with metabolic syndrome and insulin resistance increased strongly and similarly with increasing body mass index. However, metabolic syndrome and insulin resistance were different compared with their respective controls in the lower 5/8 of the distribution, in waist/hip ratios, fasting and 1-h insulin, HDL-cholesterol, heart rate, and systolic BP responses to exercise and plasma renin, angiotensin, and aldosterone. CONCLUSIONS: The findings suggest that metabolic syndrome and insulin resistance are not synonymous anthropometrically, metabolically, hemodynamically, or hormonally in patients with high-normal BP. |
| Methods Of Measuring The Peripheral Vascular Resistance Of Patients With High Blood Pressure. Kimura, T., M. Kato, et al. (1965), Saishin Igaku 20: 191-5. |
| Methonium halides in high blood pressure Smirk, F. H. (1951), Science 114(2949): 4-5. |
| Methyl-DOPA (Aldomet) in the treatment of high blood pressure. van, D. C., J. M. Coenegracht, et al. (1963), Ned Tijdschr Geneeskd 107: 152-4. |
| Methyl-dopa (Aldomet), a new principle in the treatment of high blood pressure. Mathisen, H. S. (1962), Tidsskr Nor Laegeforen 82: 353-5. |
| Microalbuminuria in subjects with no history of diabetes mellitus and hypertension: the relationship with hyperglycemia and high blood pressure at non-diagnostic level Ishibashi, F., K. Ishida, et al. (1990), Hiroshima J Med Sci 39(2): 57-60. Abstract: 1969 subjects underwent albumin index A.I., urine microalbumin (mg/liter)/creatinine (g/liter) in early morning urine, 75 g oral glucose tolerance test (OGTT), determination of plasma lipids (total cholesterol, triglyceride and high density lipoprotein-cholesterol) and a resting electrocardiogram. There was no history of treatment for diabetes mellitus and hypertension. The relationship between microalbuminuria, and hyperglycemia or high blood pressure at non-diagnostic level was examined. Then, plasma lipid levels or changes in electrocardiogram were correlated with the degree of microalbuminuria. Subjects were divided into 4 groups according to 75 gOGTT and into 3 groups according to blood pressure based on WHO definition, and A.I. was divided into 4 categories (0-9.9, 10.0-19.9, 20.0-49.9, and 50.0-199.9 mg/gCr). Mildly or moderately enhanced microalbuminuria (A.I.) was found in subjects with hyperglycemia or high blood pressure at non-diagnostic level. In normotensive subjects, neither hyperglycemia in fasting nor after glucose challenge increased urine microalbumin above normal range, while in borderline hypertensives, diabetic glucose intolerance produced 2 and 3 fold increases respectively compared with normotensives. There was a linear increase in urine microalbumin in relation to the glucose intolerance in newly diagnosed hypertensives. No correlation could be found between microalbuminuria and plasma lipid levels, while the prevalence of electrocardiographic changes increased 3 folds in group with the heaviest microalbuminuria compared with the other 3 groups excreting less microalbumin. |
| Microalbuminuria, high blood pressure burden, and nondipper phenomenon: an interaction in normotensive type 1 diabetic patients Cohen, C. N., F. M. Albanesi, et al. (2001), Diabetes Care 24(4): 790-1. |
| Microfilter paper method for antipyrine determination in whole blood by high pressure liquid chromatography Loche, S., A. B. Rifkind, et al. (1986), Ther Drug Monit 8(2): 214-8. Abstract: A method for measuring antipyrine in whole blood collected on filter paper is described. A 6.2-mm diameter disc (1/4 in) is punched out, eluted with distilled water, and then extracted with 5 ml of dichloromethane/pentane (50:50, vol/vol). After reconstitution of the dried residue, reverse-phase high pressure liquid chromatography is used to quantitate antipyrine using an internal standard. A mixture of 15% acetonitrile in 0.006 M phosphate buffer pH 7.2 was used as the mobile phase. Chromatography was carried out under isocratic conditions for 15 min. The retention time of antipyrine was 3.6 min. Intra- and interassay coefficients of variation were 3.1% and 7.2%, respectively. The limit of sensitivity was 6 ng/injection. The amount of blood in a 6.2-mm filter paper disc was calculated to be 8.4 +/- 0.8 (SD) microliter. Antipyrine half-lives, apparent volumes of distribution, and metabolic clearance rates measured from the filter paper concentrations or directly from plasma were virtually identical. Antipyrine was stable on filter paper for less than or equal to 6 weeks at room temperature. The method reported is convenient; requires a small amount of blood, which can be easily obtained by fingerstick; and readily permits the measurement of antipyrine clearance in the pediatric as well as adult populations. |
| Mineralocorticoids, salt and high blood pressure Gomez-Sanchez, E. P., M. Zhou, et al. (1996), Steroids 61(4): 184-8. Abstract: Essential hypertensive patients often respond to treatments mitigating mineralocorticoid action, even though circulating levels of these steroids are within normal ranges. In addition to the kidney, mineralocorticoid or Type I receptors are found in the brain and vascular smooth muscle where they mediate effects associated with several forms of experimental hypertension. Studies in which discrete anatomic or functional areas of the brain have been ablated demonstrate that the periventricular areas of the hypothalamus and the central sympathetic and baroreceptor systems are crucial for the development of hypertension in the renoprival, DOCA salt, and Dahl salt-sensitive rat. Intracerebroventricular (i.c.v.) infusion of aldosterone in both rats and dogs at doses that do not raise serum levels above normal produce hypertension. The hypertension produced by systemic mineralocorticoid excess, adrenal regeneration, and i.c.v. or oral administration of glycyrrhetinic acid or carbenoxolone in genetically normotensive rats and by dietary salt in the Dahl salt-sensitive rat is inhibited by the i.c.v. infusion of a mineralocorticoid receptor antagonist or a Na+ channel-selective amiloride analog. Recent data demonstrate the extraadrenal synthesis of steroids in aortic endothelial cells, smooth muscle cells and the brain. The role of the extraadrenal synthesis of steroids raises new avenues for research into the causes of hypertension. |