Trandolapril, but not Verapamil nor their association, restores the physiological renal hemodynamic response to adrenergic activation in essential hypertension

Relationship between GFR and Albuminuria in Stage 1 Hypertension

“…In healthy participants, a moderate adrenergic stimulation causes renal vasoconstriction, which protects the glomerulus from the transmission of a high systemic pressure (22). This mechanism may be abolished in hypertensive patients (23), which may account for the decline in GFR found in our originally hyperfiltering participants. Several other mechanisms not explored in this study may contribute to development of renal dysfunction in participants with glomerular hyperfiltration.…”

“…Angiotensin converting enzyme inhibitors and angiotensin receptor blockers proved highly effective in decreasing glomerular hypertension in experimental models of renal injury (31,32) and it has been demonstrated that reverting glomerular pressure to normal delays renal dysfunction, despite persistence of hyperfiltration (33). Renin-angiotensin-aldosterone system inhibition appears particularly useful in hypertensive participants with hyperadrenergic activity because it may restore the physiologic renal hemodynamic response to adrenergic activation (23). Our findings suggest that intervention to reduce GFR might benefit young hypertensive participants who hyperfiltrate, even before the onset of microalbuminuria.…”

Factors Associated With Glomerular Hyperfiltration in the Early Stage of Hypertension

“…11 Recently, Lambertucci et al found that the renal response to adrenergic activation induced by a mental stress was impaired. 10 In these subjects the physiological glomerular vasoconstriction, which prevents the transmission to the glomerulus of high BP during systemic adrenergic activation, was abolished, suggesting that in hypertension the glomerulus may be exposed to the injury caused by emotional stimuli in everyday life. 10 The association of coffee consumption with increased GFR found in the present study may be also due to increased sympatho-adrenergic activity.…”

“…10 In these subjects the physiological glomerular vasoconstriction, which prevents the transmission to the glomerulus of high BP during systemic adrenergic activation, was abolished, suggesting that in hypertension the glomerulus may be exposed to the injury caused by emotional stimuli in everyday life. 10 The association of coffee consumption with increased GFR found in the present study may be also due to increased sympatho-adrenergic activity. Urinary epinephrine and norepinephrine and vanillylmandelic acid have been shown to increase after caffeine administration in humans.…”

“…4 , [6][7][8][9] Recent research has shown that increased response to stress may also contribute to the initiation and/or exacerbation of renal dysfunction in hypertensive individuals. 10 Increased adrenergic tone raises renal plasma flow and may lead to increased glomerular intracapillary pressure and hyperfiltration. 11 Among 505 young-tomidddle-age hypertensive participants to the Hypertension and Ambulatory Recording Venetia Study (HARVEST) we previously observed that 20% of the patients had glomerular hyperfiltration (GFR ≥150 ml/min/1.73 m 2 ) which implied an increased risk of developing microalbuminuria in subsequent years.…”