The Effect of Phentolamine on Active and Inactive Renin Release in Human Renovascular Hypertension

Abstract

1. Phentolamine was infused at low increasing doses (0.2, 0.3, 0.4 and 0.5 mg/min) in five patients with unilateral renal artery stenosis measuring active and inactive (cryoactivable) renin in the renal veins from the stenosed and nonstenosed kidney and in a peripheral vein.2. PRA values from the stenosed kidney (1 1.59, s.e.m. = 5.79 pmol ang I/ml per h) were higher than those in the peripheral vein (5.19, s.e.m. =2.64) while these latter were similar to those from the contralateral kidney (5.09, s.e.m. =2.93). Phentolamine significantly increased PRA from the stenosed kidney and in the peripheral vein in a dose-related manner. PRA changes were unrelated both to blood pressure decrements and to heart rate increments induced by the drug.3. Before phentolamine, inactive renin from the stenosed kidney (5.19, s.e.m. =2.84 pmol ang I/ml per h) did not differ significantly from that on the contralateral side (3.15, s.e.m. = 1.96) and in the peripheral vein (4.40, s.e.m. = 1.96). Phentolamine induced significant (P<O.OOS) increments of inactive renin only from the stenosed kidney at the doses of 0.3, 0.4 and 0.5 mg/min. Inactive renin from the contralateral kidney was unchanged and it tended to increase, but not to a significant extent, in the peripheral vein. A highly significant relationship was found between active and inactive renin from the stenosed kidney (r=0.79, P<O.OOl, n = 2 5 ) and in peripheral blood (r =0.71, P<O.OOl, n = 25) but not from the stenosed kidney (r=0.29, n=25).4. These results suggest that phentolamine, infused at low increasing doses causes an increase of PRA only in the stenosed kidney, an action which does not seem to be wholly explained by either sympathetic nervous system activation or decrease of renal perfusion pressure, and which suggests an action on intrarenal cr-adrenoreceptors. Furthermore, phentolamine stimulated inactive renin release only from the stenosed kidney without evidence of intrarenal conversion of the inactive into the active form.

Vascular renin-angiotensin system and neurotransmission in hypertensive persons.

“…- 32 What is important to consider is that in our experimental model, the local isoproterenol plasma concentrations that we reached are high and their effect is not confused by reflexogenic adjustments caused by a systemic route of administration. For these reasons, it is quite difficult to compare results obtained in such different experimental conditions.…”