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Objective: To evaluate the value of captopril challenge test (CCT) in the diagnosis of primary aldosteronism (PA). Methods: A total of 674 patients [(45.0±13.7) years, men 341, women 333] admitted to Peking Union Medical College Hospital from 2000 to 2015 were analyzed. Among them, 222 subjects were with essential hypertension (EH), 28 were with pheochromocytoma (PHEO), 246 were with idiopathic hyperaldosteronism (IHA) and 178 were with aldosterone producing adenoma (APA). All patients received CCT. 24 h urine sodium was measured in partial patients. Plasma renin activity (PRA), aldosterone (ALD) were detected. Results: Compared with EH [PRA: before 0.5(0.2, 0.9) μg·L(-1)·h(-1,) after 0.8(0.4, 1.5) μg·L(-1)·h(-1;) ALD: before (393±122) pmol/L, after (360±97) pmol/L] and PHEO [PRA: before 0.3(0.1, 0.9) μg·L(-1)·h(-1,) after 0.4(0.1, 1.6) μg·L(-1)·h(-1;) ALD: before (396±108) pmol/L, after (374±114) pmol/L], lower levels of PRA and higher levels of ALD before and after CCT were observed in PA patients [PRA: before 0.1 (0.1, 0.2) μg·L(-1)·h(-1,) after 0.1 (0.1, 0.2) μg·L(-1)·h(-1;) ALD: before (468±216) pmol/L; after (457±199) pmol/L]. After CCT, the suppression rate of ALD [2.8% (-8.8%, 15.4%) vs 6.6% (-4.3%, 17.6%)] and increasing rate of PRA [0(0, 50%) vs 50%(0, 200%)] in PA patients were lower than those in EH patients. The ALD/PRA ratio (ARR) were higher in PA than that in EH or PHEO patients. In the EH subjects, ALD levels of seated posture were higher than those of recumbent posture both before and after receiving captopril, but with no changes in ARR after CCT. No significant differences in ALD and ARR (before and after receiving captopril) were observed between seated and recumbent position in the PA group. The ARR after CCT tended to decrease in EH subjects with elevated urine-sodium compared with those with normal urine-sodium. No changes could be viewed in ALD and PRA levels between normal urine-sodium and elevated urine-sodium groups among APA, IHA and EH patients either before or after CCT. Among patients with APA, the ALD levels before CCT and the ARR after CCT were lower in the patients with AngiotensionⅡ(AngⅡ) reactive than those without. A ROC curve analysis suggested that the optimal cutoff value was 46.2 (ALD unit: ng/dl; PRA unit: μg·L(-1)·h(-1)) for ARR after challenge in diagnosing PA, with the sensitivity of 88.7% and specificity of 84.8%. Conclusions: ARR after 25 mg captopril had high sensitivity and specificity in diagnosis of PA with the cutoff of 46.2. Seated CCT could replace recumbent CCT as a more confirmatory test. The PRA increasing rate should be taken into consideration when diagnosis of PA.

Objective: To investigate the diagnostic value of plasma aldosterone-to-active-renin ratio(ARR)in combination with plasma aldosterone concentration(PAC)in the predication of aldosteronoma(APA)., Methods: A total of 85 APA and 155 essential hypertension(EH)patients from January 2012 to December 2014 in Chinese PLA General Hospital were enrolled. The ROC curve was applied to calculate the optimal cut-off points of ARR for APA., Results: (1)The optimal cut-off point of supine ARR was 1 707.4(pmol/L)/(μg·L(-1)·h(-1))[61.64(ng/dl)/(μg·L(-1)·h(-1))] with the sensitivity, specificity and accuracy of 89.41%, 80.65% and 83.75%, respectively. The specificity and accuracy of the diagnostic value for APA increased (89.03% and 87.5% respectively) when supine ARR cut-off point were used in combination with supine PAC over 329.4 pmol/L. (2) The optimal cut-off point of upright ARR was 741.5 (pmol/L)/(μg·L(-1)·h(-1))[26.77(ng/dl)/(μg·L(-1)·h(-1) )]with the sensitivity, specificity and accuracy of 85.88%, 91.61% and 89.58%, respectively. Similarly, the specificity and accuracy greatly improved (94.84% and 91.67%, respectively) when upright ARR were applied together with upright PAC over 323.1 pmol/L., Conclusions: Both spine and upright ARR can be used in screening for APA. Moreover, the specificity and accuracy could be improved when ARR and PAC were used together both in the supine and upright position.

Objective: To investigate the optimal cutoff of plasma aldosterone to rennin concentration ratio (ARR) determined by an automated chemiluminescent immunoassay for primary aldosteronism (PA) screening., Methods: A total of 154 hypertensive patients and 83 healthy volunteers were recruited in the study. Blood for aldosterone and rennin were collected from patients in the supine position and from patients and healthy volunteers after 2-hour upright posture. Plasma aldosterone concentration(PAC) and plasma rennin concentration(PRC) were determined with the automated chemiluminescent immunoassay. The diagnoses of PA were made based on clinical manifestations, confirmatory tests and pathologic results. A ROC curve analysis was performed to determine the optimal ARR cutoffs for PA., Results: Fifty-three patients were diagnosed with PA, 85 were with essential hypertension and 16 were with other types of endocrine hypertension. In hypertensive patients, the areas under the ROC curves (AUCROC) of ARR were 0.962 (95%CI 0.933-0.990, P<0.01) in the supine position and 0.980 (95%CI 0.962-0.998, P<0.01) after 2-hour upright posture, respectively. The AUCROC of ARR was higher than that of either PAC or PRC in the same position. The highest Youden's index of ARR in the upright posture was 0.85 with the cutoff value of 119.1 pmol/mU [4.3 (ng/dl)/(mU/L)] (sensitivity 94%, specificity 91%)., Conclusion: ARR in the upright position by the automated chemiluminescent immunoassay provides a high efficiency screening test for PA. The optimal cutoff of ARR is 119.1 pmol/mU.

Objective: Cushing's syndrome is a clinical condition resulting from chronic exposure to excess glucocorticoid. As a consequence, long-term hypercortisolism contributes significantly to the development of systemic disorders by direct and/or indirect effects. The present study was to analyze the changes of renin-angiotensin-aldosterone-system in different subtypes of Cushing's syndrome on the standard posture test., Methods: We retrospectively reviewed 150 patients with histologically confirmed Cushing's syndrome treated at the PLA General Hospital between 2002 and 2014. Among them, 128 patients were diagnosed as adreno-cortico-tropic-hormone (ACTH)-independent Cushing's syndrome, and 22 were ACTH-dependent Cushing's syndrome. All patients were undertaken the posture test. Plasma renin activity (PRA), angiotensin II, plasma aldosterone concertration (PAC) levels were measured before and after the test., Results: Basal plasma PRA [0.5 (0.2,1.3)µg·L(-1)·h(-1), angiotensin II [(48.9±20.1) ng/L] and PAC [(285.0±128.1) pmol/L] levels were within the normal range in supine position. Compared with the subjects with ACTH-independent Cushing's syndrome, the basal PAC levels were higher in subjects with ACTH-dependent Cushing's syndrome [(348.0±130.4) pmol/L vs (274.2±125.0) pmol/L, P<0.05]. However, the PAC response in subjects with ACTH-dependent Cushing's syndrome [(49.7±26.4)%] was significantly lower than that in those with ACTH-independent Cushing's syndrome [(81.2±69.3)%] upon upright posture stimulation (P<0.05). There were no statistical significances in PRA and angiotensin II levels between the two groups. The basal PAC and PRA levels were positively correlated with ACTH, whereas PAC response was negatively correlated with ACTH., Conclusions: The renin-angiotensin-aldosterone-system activity in subjects with Cushing's syndrome was similar to that in normal control. The basal PAC level and its response to upright posture are differently associated with ACTH level in Cushing's syndrome.

Objective: To characterize the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) and aldosterone/renin ratio (ARR) in patients with aldosterone-producing adenoma (APA)., Methods: We retrospectively analysed the data of PRA, PAC and ARR from 80 patients with APA, 70 patients with essential hypertension (EH) and 26 individuals with normal blood pressure (NBP). Patients with hypertension were further divided into taking anti-hypertensive drug group (D) and non drug treatment group (ND). All participants received at least one following tests:ARR screening test, supine-upright position test and saline load test.Receiver-operating characteristic (ROC) analysis was used for exploring the best cut-off value of ARR and low PRA., Results: The median and percentages of PRA (ng×ml(-1)×h(-1), 1 ng×ml(-1)×h(-1) = 1 µg×L(-1)×h(-1)), PAC (ng/dl, 1 ng/dl = 27.7 pmol/L) and ARR (ng×dl(-1)/ng×ml(-1)×h(-1)) between NBP and EH (ND) groups showed no differences.Over 90% supine PRA ≥ 0.52 and 100% upright PRA ≥ 0.52 in the above two groups. On the contrary, 90% APA (ND) patients upright PRA <0.52. The lowest supine and upright ARR in APA (ND) patients was ≥ 24.2 and ≥ 37.5 respectively. ROC analysis suggested that the best screening cut-off values for APA were supine ARR ≥ 26.0, upright ARR ≥ 37.0; and low PRA cut-off value for APA were supine PRA <0.50 and upright PRA < 0.63 respectively. The sensitivity and specificity for APA diagnosis were about 88.2% and 61.5% when PAC ≥ 10.0 after saline load test., Conclusions: The distinguishing features of PRA, PAC and ARR can be used as a diagnostic indexs for the exclusive diagnosis of APA in various clinical tests. And low PRA cut-off values exist in APA patients.

Objective: Recent studies showed that adenosine played important roles in vasodilation. This study aimed to investigate the effects of adenosine, its A1 and A2b receptor agonists on pulmonary artery hypertension (PAH) induced by chronic hypoxia in rats by continuously subcutaneous administration with an osmotic pump for 14 days, and to see if rennin angiotensin system and inducible nitric oxygen synthase (iNOS)/nitric oxide (NO) mediate the effects., Method: Fifty-six male SD rats were randomly assigned to seven groups. Each group included eight rats. They were normoxic group, hypoxic group, adenosine-treated group [adenosine was administered at a dose of 150 µg(kg·min) under the hypoxic condition], adenosine A1 receptor agonist CPA-treated group [CPA was administered at a dose of 20 µg/(kg·min) under the hypoxic condition], CPA plus selective adenosine A1 antagonist DPCPX-treated group [CPA and DPCPX were administered simultaneously under the hypoxic condition, the dose of CPA was the same as the above, and the dose of DPCPX was 25 µg/(kg·min)], adenosine A2b receptor agonist NECA-treated group [NECA was administered at a dose of 30 µg/(kg·min) under the hypoxic condition], NECA plus selective adenosine A2b receptor antagonist MRS-treated group[ NECA and MRS1754 were administered simultaneously under the hypoxic condition, the dose of NECA was the same as the above, and the dose of MRS1754 was 50 µg/(kg·min)]. Osmotic pumps containing adenosine or selective adenosine A1 receptor agonist (CPA), or nonselective but potent adenosine A2b receptor agonist (NECA) were placed subcutaneously 7 days after hypoxia and continuously administered the agents for 14 days.Mean pulmonary artery pressure (mPAP) was detected after administration of the agents. Then blood samples were taken from heart for measurement of renin activity, angiotensin II (AngII) and endothelin-1 (ET-1) concentration by radioimmunoassay, NO by measuring nitrate. Small pulmonary arteries were prepared for immunoreactivity staining of proliferating cell nuclear antigen (PCNA) and iNOS., Result: (1) Chronic hypoxia induced PAH [mPAP: (31.38 ± 3.42) mm Hg]. Adenosine or CPA or NECA administered for 14 days by subcutaneous route attenuated the mPAP [(21.17 ± 3.56) mm Hg, (22.88 ± 2.95) mm Hg, (19.81 ± 2.39) mm Hg, respectively], which showed significant difference when compared with hypoxia group (P < 0.05 respectively). (2) Plasma rennin activity and AngII level in hypoxia group [(2.51 ± 0.25) ng/(ml·h), (83.01 ± 9.38) pg/ml] were significantly higher than that in normoxic group (P < 0.05, respectively).(3) Adenosine treatment decreased the rennin activity and AngII level when compared with hypoxic group(P < 0.05, respectively);CPA and NECA attenuated respectively the rennin activity and AngII level of rats induced by chronic hypoxia (P < 0.05, respectively). (4) Adenosine administration for 14 days attenuated the wall thickness induced by chronic hypoxia (P < 0.05). CPA showed no effect on wall thickness, but NECA significantly attenuated the wall thickness (P < 0.05). (5) The number of iNOS staining positive cells in small pulmonary artery was higher in hypoxia group than in that in normoxic rats (23.75 ± 7.91 vs. 8.00 ± 2.20, P < 0.05). Adenosine or CPA, or NECA administration increased respectively the iNOS expression in rats treated with chronic hypoxia. Chronic hypoxia caused significant decrease of nitric oxide level. Adenosine treatment increased the nitric oxide level in rats treated with chronic hypoxia. CPA and NECA also increased respectively the nitric oxide level in rats treated with chronic hypoxia. Chronic hypoxia caused significant increase of ET-1 level. The ET-1 level in rats treated with adenosine, CPA or NCEA respectively were lower than that in chronic hypoxia rats (P < 0.05). (6) Adenosine treatment partially attenuated the number of PCNA-positively stained cells. NECA treatment also attenuated the PCNA expression, but CPA showed no effect., Conclusion: Adenosine and its agonists CPA, NECA administered continually by subcutaneous route attenuate mPAP of rats induced by chronic hypoxia. CPA attenuates mPAP through reduction of RA/AngII activity and balance of NO/ET-1 level. NECA attenuates mPAP by inhibiting PCNA expression and proliferation of mooth muscle of pulmonary artery.

The study is to observe the effect of racemic TJ0711 on blood pressure and heart rate as well as protection of cardiovascular system of renal hypertensive rats after long-term administration. The renal hypertensive models were established by the two-kidney, one-clip (2K1C) method in Wistar rats. Four weeks later, assigned the rats whose SBP had increased at least 4 kPa randomly into 5 groups: racemic TJ0711 10, 20 and 40 mg x kg(-1) groups, carvedilol control group, model group and sham group (n=10), ig administration once daily. The changes of BP (blood press) and HR (heart rate) before and after administration were measured by tail-cuff method weekly. Plasma samples of all animals were taken in 6-8 weeks, and plasma MDA as well as renin, angiotensin II (Ang II) and endothelin-1 (ET-1) levels were measured. Left ventricle was cut off after 9 weeks, and left ventricular weight index (LVWI) and hydroxyproline were measured. The significant decrease of the BP of TJ0711 40 mg x kg(-1) group was observed after TJ0711 ig administration for 4 weeks, and this effect remained till the end of the study. In 8th week, the systolic blood pressure values were: TJ0711 40 mg x kg(-1) group 18.93 +/- 1.82 kPa (vs 21.30 +/- 2.30 kPa, P < 0.05); 20 mg x kg(-1) group 20.68 +/- 3.29 kPa (vs 22.19 +/- 2.88 kPa). The plasma MDA level of all treated groups was significantly lower than that of model group, so were the plasma renin, Ang II and ET-1 levels (P < 0.05). LVWI and hydroxyproline content of myocardial tissue decreased to some extent, but was not significant as compared with that of model group. The study showed that TJ0711 repeated dosing could reduce BP level beginning from drug administration; besides block adrenal alpha and beta receptors to play an antihypertensive role. The sustained antihypertensive effect also related to reduce plasma vasoconstrictor substances and oxidation product MDA. These effects benefited cardiovascular protection.

Objective: To study on the difference of plasma renin activity (PRA), angiotensin II (Ang II), and aldosterone levels in patients with essential hypertension (EH) or primary aldosteronism (PA) or pheochromocytoma (PHEO), and to analyze the sensitivity and specificity on the diagnosis of PA among patients with hypertension with aldosterone/PRA ratio (ARR)., Methods: The plasma aldosterone, Ang II and PRA concentrations in supine and upright positions were measured by radioimmunoassay from 413 patients including idiopathic hyperaldosteronism (IHA, n = 111), aldosterone-producing adenoma (APA, n = 118), PHEO (n = 98) and EH (n = 86). ARR was calculated., Results: Plasma aldosterone concentrations in both of supine and upright positions in PHEO group [374 (294, 465) pmol/L and 629 (449, 997) pmol/L] and PA group [471 (346, 632) pmol/L and 673 (499, 825) pmol/L] were higher than those in EH group [277 (224, 332) pmol/L and 427 (341, 501) pmol/L] (P < 0.01). They were also higher in APA group [576 (416, 731) pmol/L and 726 (554, 906) pmol/L] than those in IHA group [399 (313, 504) pmol/L and 609 (485, 776) pmol/L] (P < 0.01). Ang II levels in both positions were lower in PA group [43.2 (26.4, 74.4) ng/L and 60.1 (38.5, 103.6) ng/L] than in EH group [56.7 (43.3, 78.9) ng/L and 84.3 (61.3, 108.4) ng/L] or PHEO group [54.3 (29.9, 101.5) ng/L and 102.8 (49.9, 167.0) ng/L] (all P values < 0.01), and there was no difference between IHA and APA group (P > 0.05). The PRA level in both positions of each group were PHEO group [0.3 (0.2, 1.0) µg · L(-1) · h(-1) and 1.4 (0.6, 3.4) µg · L(-1) · h(-1)] > EH group [0.2 (0.1, 0.4) µg · L(-1) · h(-1) and 0.6 (0.4, 1.0) µg · L(-1) · h(-1)] (P < 0.01) > PA group [0.1 (0.1, 0.1) µg · L(-1) · h(-1) and 0.2 (0.1, 0.3) µg · L(-1) · h(-1)] (P < 0.01), and APA group [0.1 (0.1, 0.1) µg · L(-1) · h(-1) and 0.1 (0.1, 0.3) µg · L(-1) · h(-1)] < IHA group [0.1 (0.1, 0.2) µg · L(-1) · h(-1) and 0.2 (0.1, 0.3) µg · L(-1) · h(-1)] (supine P < 0.01; upright P < 0.05). APA was divided into 2 types with renin-Ang II-responsive APA (n = 26) and unresponsive APA (n = 92). The plasma aldosterone concentration was lower in supine position but higher in upright position in renin-Ang II-responsive APA than in unresponsive APA patients. ARR in upright was higher in PA group (P < 0.01) but lower in PHEO group (P < 0.05) compared with EH. ARR was higher in APA than in IHA (P < 0.01). The sensitivity and specificity of ARR as 40 (aldosterone unit: ng/dl; PRA unit: µg · L(-1) · h(-1); its value should multiply 27.7 when transferred to pmol/L, simili) were 93% and 76%, respectively., Conclusion: The levels of PRA, Ang II and aldosterone from patients with EH, PA and PHEO are significant different. ARR as 40 in upright position could be used for PA screening cutoff point.

Objective: To Investigate the influences of chronic intermittent hypoxia (CIH) and continuous hypoxia (CH) on renin angiotensin system (RAS) in serum and tissues of rats, and therefore to investigate the mechanism of CIH-induced hypertension and hypoxia induced pulmonary hypertension., Methods: Eighteen male Sprague-Dawley (SD) rats were divided into 3 groups: CIH group, CH group and control group (UC). CIH rats were subjected to alternating cycles of hypoxia (6% ∼ 8% O(2) in N(2) for 20 ∼ 25 s) and normoxia (21% O(2) in N(2) for 2 min) every 180 s for 7 h/d. CH rats were consistently given nitrogen (oxygen concentration 8% - 12% in the cabin, 7 h/d), while the UC rats were not treated., Results: Systolic blood pressure (SBP) in the CIH rats at the end of 6th week was significantly elevated compared with baseline SBP (P < 0.001), and that in the CH and the UC rats (P < 0.05). At the end of 6th week, the expression of ACE and ACE2 in the renal arteriole was significantly different (P < 0.05), and the levels of AngII in serum and kidney tissues were increased. Ang-(1-7) was decreased in the CIH rats compared with the CH and the UC rats (P < 0.05). The levels of AngII in pulmonary tissues were increased, while the levels of Ang-(1-7) were decreased in the CH rats compared with the CIH and the UC rats (P < 0.05). SBP showed a positive correlation with AngII in serum and kidney tissues, and a negative correlation with Ang-(1-7) in serum and kidney tissues. There were significant differences in arterial wall thickness, WT%, and WA% of renal arterioles and pulmonary arterioles among the 3 groups. Wall thickness of pulmonary arterioles and kidney arterioles was positively correlated with AngII in pulmonary and kidney tissues (r = 0.386, 0.414, P < 0.05), and negatively correlated with Ang-(1-7) (r = -0.401, -0.394, P < 0.05)., Conclusion: CIH and CH showed different effects on RAS in the serum and the tissues of rats. CIH mainly affected levels of RAS in the serum, kidney tissues and renal arterioles, and was closely related with blood pressure. CH mainly affected the levels of RAS in lung tissues and pulmonary small arteries, which may be related with pulmonary, hypertension and pulmonary arterial remodeling.

Objective: To observe the effect of Tiangou Jiangya capsule (TJC) on blood pressure in renovascular hypertension rats and explore its possible mechanism., Method: Seventy-two Wistar rats were randomly divided into normal control group, model group, captopril group, TJC small, medium and high dose groups. Non-invasive blood pressure measurement was used to detect the arterial blood pressure of rat tails. PRA, Ang II , ALD, 6-Keto-PGF1alpha, ET and TXB2 content in blood was measured by radioimmunoassay. NO content in blood was determined by method of nitrate reductase., Result: The systolic, diastolic and mean pressure significantly increased, serum PRA, Ang II , ALD decreased, ET levels significantly increased in model group rats. TJC significantly reduced blood pressure, improved the plasma renin activity, decreased ET levels and increased NO content of model rats., Conclusion: TJC can reduce blood pressure of renovascular hypertention rats, and the mechanism may be related to its regulating lower blood pressure regulation of the secretion of RAAS system and improving vascular endothelial function.

Objective: To study the effect of Qianyang Recipe (QYR) on the Gan-yang hyperactivity syndrome (GYHS), the blood pressure, and correlated vascular regulatory factors of hypertension rat., Methods: Thirty SD rats were randomly divided into the normal control group, the model group, and the QYR group, ten in each. Hypertension rat model of GYHS was prepared using Aconiti Praeparata Decoction plus ephedrine plus salt water. Rats in the QYR group orally took QYR physic liquor, while distilled water was given to rats in the normal control group and the model group. They were medicated for 28 successive days. The facial temperature, the grip strength, and the systolic pressure were determined once every 7 days. Rats' irritable degree and feather color were observed and recorded once every 14 days. After the last administration the plasma renin (PR), angiotensin II (Ang II), aldosterone (ALD), atrial natriuretic peptide (ANP), calcitonin gene-related peptide (cGRP) were determined., Results: Compared with the model group of the same phase, the facial temperature of rats in the QYR group significantly decreased on the 14th, 21th and 28th day after administration. The systolic pressure obviously decreased on the 21st day after administration. On the 28th day after administration symptoms such as irritability, dry hair were improved, and the Ang II level decreased. There was significant difference in all these changes (P<0.05, P<0.01)., Conclusions: QYR could relieve GYHS rats' symptoms such as facial hotness, irritability, dry hair, and so on, and decrease the systolic pressure. Decreased Ang II level might be one of its mechanisms.

Objective: To evaluate the accuracy of combing serum aldosterone to plasma rennin ratio (ARR) and low renin level in diagnosing primary aldosteronism (PA)., Methods: The ratio of serum aldosterone to plasma renin was determined in 100 patients with PA and 61 patients with primary hypertension. The optimum cut-point of ARR was determined by the Receiver Operating Characteristic (ROC). The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and Youden index of the ARR at the optimum cut-off point were calculated in a separate test. The sensitivity and specificity of combining ARR and low renin level or high aldosterone level in diagnosing PA were determined., Results: The supine ROC area under the curve (AUC1) was 0.991. The erect ROC area under the curve (AUC2) was 0.988. The AUC1 and AUC2 had no significant difference (P = 0.879). But they were both different significantly from with the area under the reference line (0.5) (P = 0.000). The optimum cut-off point of supine ARR was 112.06, with 0.96, 0.95, 0.91, 19.59 and 0.04 in sensitivity, specificity, Youden index, positive likelihood ratio and negative likelihood ratio, respectively. Combining ARR and low renin level produced a sensitivity and specificity of 0.422 and 0.998, respectively, in diagnosing PA. Combining ARR and high aldosterone level produced a sensitivity and specificity of 0.854 and 0.994, respectively in diagnosing PA. The optimum cut-off point of erect ARR was 36.61, with 0.99, 0.93, 0.92, 15 and 0.01 in sensitivity, specificity, Youden index, positive likelihood ratio and negative likelihood ratio, respectively. Combining ARR and low renin level produced a sensitivity and specificity of 0.941 and 0.986, respectively, in diagnosing PA. Combining ARR and high aldosterone level produced a sensitivity and specificity of 0.604 and 0.999, respectively in diagnosing PA., Conclusion: Erect ARR (> or = 36.61) can be used in detecting PA. Combining ARR and low renin level improves the accuracy in diagnosing PA and reduces misdiagnosis. The method is simple and available. It can be carried out in the out-patient department.

Objective: To determine the effects of irrigation fluid absorption on system hemodynamics, fluid-electrolyte and hormone during mini-percutaneous nephrolithotomy., Methods: In this study 128 patients with renal calculus or calculus of superior ureter from January 2007 to February 2008 were collected. Hemoglobin (Hb), hematocrit (Hct), plasma osmotic pressure (POP), fluid-electrolyte, serum creatinine (Cre), renin, angiotensin II and aldosterone were determined before and after operation. Heart rate (HR), mean arterial blood pressure (MAP) and oxygen saturation (SPO(2)) were recorded dynamically every 30 min., Results: The HR speeded up accompanied with the irrigation time. When compared with before operation, POP, Cl(-), renin and Cre were significantly increased after operation; Hb, Hct and K(+) were significantly decreased after operation; MAP, SPO(2), Na(+), aldosterone and angiotensin II did not change significantly after operation. No serious surgery-related complication occurred in all patients., Conclusions: Irrigation fluid is absorbed during mini-percutaneous nephrolithotomy. The absorption amount is positively correlated with irrigation time. Changes of hemodynamics, fluid-electrolyte balance and renin may be caused by the irrigation fluid absorption.

Objective: In recent years, the assessment of the plasma aldosterone-to-renin ratio (ARR) has become a most effectively and commonly used method for screening primary aldosteronism from hypertensive patients. It is known that there is a large variance in ARR value between races and ARR is affected by many factors, such as drugs, posture and serum potassium etc. The objective of this study is to establish the threshold of ARR for screening primary aldosteronism in Chinese hypertensive patients., Methods: A total of 110 hypertensive patients were recruited and divided into essential hypertension group (n=65) and adenoma/hyperplasia group (n=45) according to the adrenal contrast CT scan. Antihypertensive drugs which can affect ARR such as beta-blockers, dihydropyridine calcium channel blockers (CCBs), ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and clonidine, were withdrawn for at least 2 weeks. Washout period for diuretics including spironolactone were 4 weeks. Non-dihydropyridine calcium channel blockers (slow released verapamil) and/or alpha-blocker (terazosin) are allowed for controlling blood pressure when needed. If the serum potassium value<3.6 mmol/L, an oral potassium supplement was prescribed. After keeping upright position for 2 hours, blood samples were drawn for PRA and PAC measurement between 9:00AM-10:00AM., Results: ARR was 100.00+/-48.65 (14.19-285.16) pg/ml vs ngxml-1xh-1 in patients with essential hypertension and 699.33+/-213.33 (185.8-2150) pg/ml vs ngxml-1xh-1 in patients with adenoma/hyperplasia. ARR value was greater than 240 in 42 out of 45 patients (93.3%) with adenoma/hyperplasia and was less than 240 in 59 out of 65 (90.7%) patients with essential hypertension. We used ARR 240 as the cut-off threshold for screening primary aldosteronism in another 178 hypertensive patients and ARR was greater than 240 in all 15 patients with confirmed primary aldosteronism., Conclusion: It is suitable to use upright ARR 240 as a cut-off threshold for screening primary aldosteronism in Chinese hypertensive patients.

Objective: To screen primary aldosteronism cases with ARR (aldosterone/plasma renin activity, ARR) from patients with hypertension, and to evaluate the diagnosis value of ARR in primary aldosteronism cases and analysis the clinical characters of primary aldosteronism cases., Methods: Nine hundred and two patients with hypertension were collected, the plasma aldosterone concentration to plasma renin activity ratio were detected by radio-immunity method, after that, ARR were calculated. Retrospective analysis was made of clinical data in 126 primary aldosteronism cases, which ARR were over 25., Results: One hundred and twenty-six cases (14%) were diagnosed as primary aldosteronism, and of them, 49 cases had hypokalemia. 25 patients received surgical operation and the rate of efficiency and cure of surgery treatment were 100% and 48%, respectively. The rate of efficiency and cure of drug treatment was 89% and 24% respectively., Conclusions: Primary aldosteronism affects over 10% of patients with hypertension in China. Patients with hypertension and most patients with treatment-resistant hypertension should undergo screening for primary aldosteronism with ARR. A high ARR is a positive screening test result, a finding that warrants confirmatory testing.

Objective: To observe the changes of plasma renin activity, antidiuretic hormone and brain natriuretic peptide in chronic heart failure (CHF) and their correlation with hyponatremia., Methods: Plasma levels of PRA, ADH, and BNP were measured by radioimmunology in 76 CHF patients. Forty-one out of 76 CHF patients with hyponatremia and 35 CHF patients without hyponatremia were identified by serum sodium. The rates of rehospitalization within 3 months were compared in two groups., Results: Levels of plasma renin activity, ALD, and BNP in CHF patients with hyponatremia were notably higher than those in patients without hyponatremia classified by New York Heart Association (NYHA) grade II - IV: PRA [(2.7 +/- 1.0) ng.ml(-1).h(-1) vs. (1.8 +/- 0.7) ng.ml(-1).h(-1), (4.3 +/- 1.2) ng.ml(-1).h(-1) vs. (3.0 +/- 0.9) ng.ml(-1).h(-1), (5.6 +/- 1.3) ng.ml(-1).h(-1) vs. (3.5 +/- 1.1) ng.ml(-1).h(-1), respectively, P < 0.05], ADH [(59.7 +/- 17.4) ng/L vs. (48.6 +/- 15.3) ng/L, (68.4 +/- 17.6) ng/L vs. (56.3 +/- 19.2) ng/L, (75.3 +/- 20.0) ng/L vs. (51.4 +/- 16.2) ng/L, respectively, P < 0.05] and BNP [(276.4 +/- 75.2) ng/L vs. (185.3 +/- 55.3) ng/L, (380.1 +/- 113.6) ng/L vs. (258.5 +/- 62.1) ng/L, (564.0 +/- 125.2) ng/L vs. (405.3 +/- 102.9) ng/L, respectively, P < 0.05]. In the simple regression analyses, hyponatremia was negative correlated with PRA, ADH and BNP (r = -0.31, P < 0.05; r = -0.28, P < 0.05, r = -0.80, P < 0.01). The rate of rehospitalization within 3 months in hyponatremia group was higher than that in control group., Conclusions: There is relation of hyponatremia to the changes of plasma renin activity, antidiuretic hormone and brain natriuretic peptide in chronic heart failure. Hyponatremia may accelerate the excretion of plasma PRA, ADH and BNP in chronic heart failure. Neuroendocrine activation in patients of congestive heart failure with hyponatremia is higher than that of normal natremia group.

Objective: To assess the value of renal vein renin , plasma endothelin (ET), nitric oxide (NO), calcitonin gene-related peptide (CGRP) in predicting the therapeutic effect of percutaneous renal artery stenting., Methods: Selective renal angiography was performed in 60 patients with coronary artery disease and hypertension. All the patients with obvious unilateral renal artery stenosis (lumen narrowing >or =50%) underwent percutaneous transluminal renal angioplasty and stenting. Bilateral renal vein and inferior vena cava plasma renin activity (PRA) and plasma ET, NO, and CGRP levels were measured and the two-year follow-up data of the patients analyzed., Results: In all the patients, PRA in the ischemic kidney was significantly higher than that in the contralateral kidney (3.89-/+3.14 vs 2.01-/+1.93 nmol/L/h, P>0.05). After renal artery revascularization with stenting, PRA in the ischemic kidney was reduced obviously (P<0.05), which was significantly lower in patients with renal vein renin ratio (RVRR)>1.5 than in those with RVRR <1.5 (1.92-/+2.15 vs 2.42-/+0.56 nmol/L/h, P<0.05]. Plasma ET level was significantly higher, whereas plasma NO level significantly lower in patients with PVRR>1.5 (P<0.05). Greater improvement of blood pressure was observed in patients with RVRR>1.5 after two years than in those with RVRR< 1.5 (P<0.05)., Conclusion: The activity of penal vein renin, plasma ET, NO, and CGRP may provide valuable information for predicting the therapeutic effect of percutaneous renal artery stenting.

Objective: To study the effect of extracellular matrix of xenogenic femoral fascia in repair of renal trauma., Methods: Twelve adult dogs were used and randomly assigned to 6 groups, and the animals were sacrificed separately in 1 and 2 weeks 1,2,4 and 8 months after renal repair operations. The examinations of blood and urine routine, blood urea nitrogen and creatinine, electrolyte and serum renin were performed before and after operations at various times. The creatinine clearances of affected and contralateral normal kidneys were evaluated before death and the local areas of renal repair were studied by light and electron microscopy., Results: Bleeding was stopped completely after the entire patch was sutured, and only mild adhesions to around tissues were found in various times after operations. As time passed, the repair patch was replaced by smooth neocapsule like normal renal capsule., Conclusion: Extracellular matrix of xenogenic femoral fascia might be an ideal tissue engineering material for renal repair.

Objective: To investigate the changes in circulatory renin-angiotensin system (RAS) in rats with endotoxemia and explore its mechanism., Methods: Ninety Wistar rats were randomly divided into normal control group (n=10) and endotoxemia groups (n=80). The endotoxemia group was further divided into subgroups of 2, 4, 8, 12, 24, 48, 72 hours and 7 days after injection of lipopolysaccharide (LPS) into the abdominal cavity (each n=10). The rats were sacrificed at different time points after LPS (10 mg/kg) challenge. Contents of plasma LPS, plasma renin activity (PRA), plasma angiotensin II (A II), angiotensin-converting enzyme (ACE), tumor necrosis factor-alpha (TNF-alpha), and interleukin-10 (IL-10) were determined., Results: (1) Plasma LPS, TNF-alpha and IL-10 reached highest levels 2 hours after LPS injection, and they returned to normal levels 7 days, 8 hours and 8 hours after LPS challenge respectively. (2) The levels of plasma PRA, A II and ACE reached highest levels 2, 8 and 8 hours after LPS challenge respectively, and they returned to normal levels 12, 24 and 72 hours after LPS injection, respectively., Conclusion: During endotoxemia, there is a series of inflammatory reactions and anti-inflammatory reactions, and a large number of cytokines and inflammatory mediators are released. At the same time, the circulating RAS is activated, which causes constriction of blood vessel and dysfunction of the microcirculation aggravating hypoxia of cells. The study of the changes in RAS is significant to interpreting the pathogenetic mechanism of endotoxemia in rats.

Objective: To observe the changes of angiotensin II (ATII) and ATII type-1 receptor (AT1R) during the development of chronic intermittent hypoxia (CIHO)-induced hypertension in rats, and the effect in the mechanism of CIHO-induced hypertension., Methods: Seventy-two male Wistar rats were divided into three groups:intermittent hypoxia group (IH), sham control group (SC) and control group (UC). By using supply of nitrogen (30 s each cycle) followed by compressed air (30 s each cycle) into the exposure chambers (4% - 6% nadir ambient oxygen with return to 21%), IH rats were subjected to intermittent hypoxia every 60 s for 8 h/d during the diurnal sleep period. SC rats were similarly treated but received compressed air instead of nitrogen. UC rats were not treated. Mean arterial pressure (MAP), the levels of ATII and renin activity (RA) in plasma as well as the expression of AT1R mRNA in tissue were measured on day 7, 21 and 42 after experiment., Results: MAP was significantly elevated in IH rats [(102.2 +/- 6.2) mm Hg, 1 mm Hg = 0.133 kPa] compared with initial MAP [(94.1 +/- 4.3) mm Hg, P < 0.01] and compared with that in SC [(95.7 +/- 3.6) mm Hg], UC [(97.2 +/- 3.6) mm Hg, all P < 0.05] on day 42. The levels of ATII and RA in plasma in IH rats increased gradually over time, and RA started to increase significantly on day 7 [(3.86 +/- 1.25) ng.ml(-1).h(-1)] compared with that in SC [(2.73 +/- 0.98) ng.ml(-1).h(-1)], UC [(2.55 +/- 0.87) ng.ml(-1).h(-1), all P < 0.05], and ATII started to increase significantly on day 21 [(214 +/- 41) ng/L] compared with that in SC [(124 +/- 21) ng/L], UC [(121 +/- 18) ng/L, all P < 0.01]. The RA and ATII levels in plasma showed positive correlation with MAP (r = 0.529, P = 0.008; r = 0.475, P = 0.019 respectively). The expression of AT1R mRNA in heart, kidney and aorta in IH rats showed no differences compared with that in SC and UC group (all P > 0.05). All indices were not different between SC and UC rats at any time point (all P > 0.05)., Conclusion: CIHO can cause the levels of circulating RA and ATII to increase, but has no effects on AT1R mRNA expression in tissue, which suggests that activated renin-angiotensin system may contribute to the pathogenesis of CIHO-induced hypertension.

Objective: To monitor the change of renin, endothelin and 6-keto-prostaglandin F1alpha in canine during left ventricular assist (LVA)., Methods: Eight canines were assisted by left assist ventricular device for 9 hours. The level of renin, endothelin and 6-keto-prostaglandin f1alpha in plasma were measured by radioimmunity analysis before assisting (control group) and at 3 hours, at 6 hours, at 9 hours after assisting., Results: The level of endothelin in plasma didn't dropped remarkably as LVA proceeded in which there was not differency in statistical diffency compared with control group[(51 +/- 11) ng/L, (42 +/- 8) ng/L, t = 0.926, P > 0.05]; The level of renin in plasma reached the summit at 3 hours during LVA compared with control group (3,036 +/- 1,411) ng/L, (1,783 +/- 467) ng/L, t = 5.013, P < 0.01) and later show dropping tendency without statistical differency at 9 hours (1 944 +/- 883) ng/L (t = 0.644, P > 0.05); The level of 6-keto-prostaglandin f1alpha in plasma at 3 hours during assisting increased remarkably [(75 +/- 17) ng/L, t = 1.411, P < 0.05), at 6 hours reached summit [(92 +/- 18)ng/L, t = 3.533, P < 0.01) and at 9 hours show dropping tendency with significant differency compared with control group (90 +/- 22) ng/L, t = 2.516, P < 0.05)., Conclusion: During 9 hours LVA, endothelin didn't dropped remarkably compared with control group and the endothelium released renin with transient increase, prostaglandin with consistent increase.

Objective: To investigate the influence of nasal continual positive airway pressure (nCPAP) on the plasma levels of thromboxane B(2) (TXB(2)), renin, angiotensin II (AT-II), endothelin 1 (ET-1), cyclic AMP (cAMP) and cyclic GMP (cGMP) and evaluate their clinical significance., Methods: 20 patients with OSAS without cardiovascular complications and 20 nromal controls were enrolled in the study, who were monitored with PSG, and then treated with nCPAP during the second night. All the plasma parameters were measured after PSG monitoring and nCPAP management with radio-immunoassay., Results: Before nCPAP, plasma levels of TXB(2), renin, and AT-II were higher in patients with OSAS than those in control (P < 0.05); Meanwhile, the plasma levels of ET-1, cAMP, and cAMP/cGMP were significantly higher in patients group than those in control (P < 0.01)., Conclusions: Patients with severe OSAS may have disturbances in neuro-regulation and changes in plasma level of TXB(2), renin, AT-II and ET-1, which indicates that the vasoactive substance might be related to the hypoxemia and disturbance in neuro-regulations, and might play an important role in the development of hypertension and other cardiovascular disorders. nCPAP therapy can correct the abnormalities of some vasoactive substances.

Objective: To investigate the association between renin-like activity (RA) and angiotensin II (A II) and the ovarian hyperstimulation syndrome (OHSS)., Methods: Blood samples were taken from 42 patients undergoing in vitro fertilization (IVF). According to the ovarian stimulating response, the patients were divided into 4 groups: group I, low responders, 7 cases; group II, moderate responders, 8 cases; group III a high responders without using albumin, 7 cases, group III b, high responders with albumin, 10 cases; group IV, severe and moderate OHSS, 10 cases. 5 patients for intrauterin insemination with natural cycle as control. Follicular fluid (FF) was collected at oocyte retrieval from 28 IVF patients (including 7 OHSS patients). Fluid from ascites and hydrothorax was obtained from 3 OHSS patients, and peritoneal fluid obtained from 5 infertility patients by laparoscopy and ascitic fluid obtained from 6 ovarian carcinoma patients served as control. RA and A II levels were measured by radioimmunoassay., Results: Plasma RA and A II levels at mid-luteal phase from OHSS patients [(19.9 +/- 19.0) micrograms.L-1.h-1 and (397.0 +/- 378.2) ng/L] were significantly higher than those from the other patients (P < 0.01-0.05), also the levels at mid-luteal phase from IVF patients were significantly higher than those at late-follicular phase [(4.1 +/- 2.9)-(4.9 +/- 3.2) micrograms.L-1.h-1 Vs (1.5 +/- 0.9)-(1.9 +/- 1.0) micrograms.L-1.h-1, (85.5 +/- 49.5)-(109.4 +/- 46.0) ng/L Vs (33.6 +/- 15.9)-(37.0 +/- 17.1) ng/L, P < 0.01-0.05]. RA and A II levels in FF were significant higher than those in plasma (P < 0.01-0.05). A II in ascitic fluid in OHSS patients was 4 to 8 times higher than that in plasma, while RA in ascitic fluid was 1.5 to 3 times higher than that in plasma, but the levels of A II and RA in controls were very low. The plasma RA and A II levels dropped very significantly along with clinical improvement (P < 0.01)., Conclusion: These findings suggest that RA and A II are associated with the pathogenesis of capillary leakage in OHSS.

In order to study the adverse effects of manganese on neuro-endocrine and cardiovascular system, radioimmunoassay (RIA) was used to test the blood prolactin concentration and plasma renin activity among manganese-exposed workers. The result showed that the blood prolactin concentration and Plasma renin activity in manganese exposed workers were significantly higher than those of control group. It suggested that manganese exposure might affect the function at tubero-infundibular area and renin-angiotensin aldosterone system.

Objective: To study the relation between hypertensive left ventricular hypertrophy (LVH) in very old people (> 80 year) with neuro-hormone factors and ventricular arrhythmias., Methods: Measurements were made on the heart rate variation, renin (Ren), angiotensin-II (AT-II), aldosterone (Ald), insulin (Ins), Holter and ambulatory blood pressure monitor in 60 cases of 2 groups: 30 with primary hypertension in very old people and LVH (group A); 30 with simple primary hypertension in very old people (group B)., Results: (1) There was no significant difference of AT-II and Ren among group A and B (P > 0.05); (2) Ins and Ald value in group A was much higher than group B (P all < 0.01); (3) Very lower frequency (VLF) and low frequency (LF) and LF/HF (high frequency) in group A were significantly higher than group B (P < 0.01, 0.05, 0.05, respectively); (4) incidence of premature ventricular beats and myocardial ischemia in group A were higher than those in group B., Conclusions: (1) Sympathetic nerve excitability in group A was greatly increased; (2) Hypertensive LVH were closely associated with Ald and Ins level, but not with AT-II and Ren; (3) There was obvious correction between group A and premature ventricular beats and ischemia.

Objective: To investigate changes of plasma renin activity(PRA) and plasma angiotensin II (PANG II) in women with polycystic ovary syndrome(PCOS)., Methods: We chose thirty PCOS women as trial group and thirty normal menstrual women as control. PRA and PANG II levels during follicularphase(FP) of the two groups were measured by radioimmunoassay., Results: PRA and PANG II increased in women with PCOS as compared with the normal FP. The increment of PRA and PANG II in PCOS women of high testosterone levels was correlated with serum luteinizing hormone/follicle-stimulating hormone and testosterone concentration., Conclusion: The elevated PRA and PANG II suggest an enhanced functional activity of ovarian renin angiotensin system in PCOS, and which may play a role in the pathologenesis of PCOS.

Objectives: To assess the utility of urinary uric acid excretion and urinary uric acid/creatinine ratio as the marker of nocturnal respiratory disturbance in patient with sleep apnea syndrome (SAS) before and after the institution of nasal continuous positive airway pressure (nCPAP). Another purpose is to explore the relationship between the nocturnal diuresis and atrial natriuretic peptide (ANP), renin-aldosterone in SAS., Methods: 22 cases diagnosed as SAS by polysomnography (PSG) were selected as trial group, 11 cases excluded from SAS by PSG were as control group, and 13 severe SAS patients were treated by nCPAP and taken as nCPAP therapy group. The markers mentioned above were compared in these groups., Results: The overnight change in urinary uric acid/creatinine ratio in trial group is 0.47 +/- 0.31, which is significantly higher than that in control group (0.01 +/- 0.23), P < 0.05, and in nCPAP therapy group after therapy (0.01 +/- 0.19) significantly lower than that before nCPAP therapy (0.48 +/- 0.27), P < 0.001. The morning urinary uric acid excretion in trial group is (5.4 +/- 2.3) mg/L which is also significantly higher than that in control group (3.2 +/- 1.4) mg/L, P < 0.001, and in nCPAP therapy group (3.3 +/- 1.2) mg/L significantly lower than that before nCPAP (5.9 +/- 2.6) mg/L, P < 0.05. The mean morning blood ANP in trial group is (0.182 +/- 0.004) microgram/L, which is higher than that in control group (0.182 +/- 0.004) microgram/L, P < 0.05, and in nCPAP therapy group (0.122 +/- 0.001) microgram/L is much lower than that before nCPAP therapy (0.180 +/- 0.003) microgram/L, P < 0.001. However there are no statistic significant differences between these groups in blood renin-aldosterone., Conclusions: The urinary uric acid excretion and overnight change in urinary uric acid/creatinine are good markers to determine the effects of nCPAP on SAS. The nocturnal diuresis in SAS patients is correlated with the increase of ANP in plasma.

Unlabelled: Objective To investigate variations of plasma renin activity, a prostaglandin I2 (PGI2) during 21 d -6 degrees head-down tilt (HDT) with and without lower body negative pressure (LBNP)., Method: -6 degrees head-down tilt for 21 d were used to simulate weightlessness. 12 healthy male, aged 23.7 +/- 5.0, were equally and randomly divided into control group (CON) and LBNP group. The latter subjected to LBNP (-30 mm Hg, 1 h/d) in the last week of HDT. Samples of plasma were taken before HDT and on the 2nd, 4th, 11th and 22nd day during HDT., Result: Compare to control levels, Ald declined significantly on the 2nd (CON -30%, P < 0. 05; V. S. LBNP -38%, P < 0.01), and increased significantly on the 11th day (CON +30%, P < 0.05; LBNP +48%, P < 0.01). PRA reached peak value on the 4th day (P < 0.05), and declined to below the control level on the 22nd day. PGI2 increased constantly during HDT, and increased significantly on the 22nd day (CON P < 0.01), 11th, 22nd (LBNP P < 0.05). No apparent difference was found between groups after LBNP concerning PRA and Ald; and PGI2 didn't increase further in LBNP group. Conclusion HDT induced a timely increasing in PRA and Ald, constant increasing in PGI2.

Objective: To investigate the changes of plasma renin activity (PRA), angiotensin converting enzyme (ACE), angiotensin II and portal venous pressure (PVP) in cirrhotic patients with ascites undergoing portacaval shunt., Methods: Serum PRA, ACE, A II levels in portal vein, artery, peripheral vein and PVP were measured in 16 cirrhotic patients with ascites before and after portacaval shunts and in control group of 16 cases of gastrointestinal carcinoma. By light colorimetric analysis and radio-immunization assay., Results: PRA, ACE, A II levels and PVP of pre- and after portacaval shunt were significantly higher in cirrhotic patients than the control group (P < 0.05), and they were significantly decreased after the shunt in the cirrhotic patients (P < 0.05). The PVP was in positive correlation to the levels of serum ACE in cirrhotic patients (r = 0.48, P < 0.01)., Conclusions: The levels of serum PRA, ACE, A II and PVP decreased significantly in cirrhotic patients with portal hypertension after portacaval shunts. It may be major causes of ascites disappearance in cirrhotic patients after portacaval shunt.

Objective: To study the changes of endothelin (ET), renin activity (RA) and angiotensin II (AT-II) before and after puerarin treatment in patients with acute myocardial infarction (AMI)., Methods: Forty-three patients with AMI were divided into two groups, and were given puerarin and glucose-insulin-kalium (GIK) treatment respectively. Plasma ET, RA and AT-II were measured by radioimmunoassay (RIA) before and after treatment in different phases., Results: It showed that plasma ET and RA, AT-II levels in AMI were higher than those in control group (P < 0.01). ET level was conversely correlated with RA and AT-II (P < 0.01). After treatment with puerarin, plasma levels of ET, RA and AT-II were recovered to normal in 3 days, but these data recovered to nearly normal until 7-14 days in group with GIK treatment., Conclusion: Puerarin might play an important role in regulating the imbalance of ET, RA and AT-II of patients with AMI.

Fifty patients with left ventricular diastolic heart failure (LVDHF), and 35 patients with left ventricular systolic heart failure (LVSHF) diagnosed by clinical manifestation and radionuclide ventriculography were studied and 20 normal persons served as controls. Plasma renin activity (PRA), angiotensin I (AT I), aldosterone (ALD), endothelin (ET) and atrial natriuretic peptide (ANP) concentrations were measured by radioimmunoassay. Fifty patients with LVDHF were divided into treatment group and control group in a randomized, double blind, control method. Enalpril, CoQ10 and VitE were given in treatment group while only CoQ10 and VitE were given in control group. The therapeutic efficacy was evaluated after 8 weeks of treatment. The results showed that plasma concentration of PRA, AT I, ALD, ET and ANP were increased in LVDHF, but lower than those in LVSHF. After treatment with enalapril plasma PRA was increased while AT I, ALD and ET level were decreased significantly but ANP level had no change in treatment group.

Objective: RAAS was determined to investigate the relationship between their changes and the dysfunction of pulmonary ventilation for evaluating the pathogenesis of early pulmonary hypertension in chronic bronchitis with or without emphysema., Methods: Angiotensin II (AT II), plasma renin activity (PRA) and aldosterone (Ald) were determined at 8:00 AM in sitting position for 30 minutes in 12 heathy nonsmokers, 50-60 years old, with normal functions of small airway, normal FEV1 and lung volumes, and in 23 patients with chronic bronchitis with or without emphysema., Results: All patients with chronic bronchitis showed dysfunction of small airway with or without abnormalities of FEV1 and lung volumes. In healthy control group, the plasma PRA, AT II and Ald levels were 0.22 +/- 0.12 microgram.L-1.h-1 (x +/- sx), 52 +/- 7 ng/L and 315 +/- 26 pmol/L respectively comparing with those levels of 0.43 +/- 0.11 microgram.L-1.h-1, 197 +/- 32 ng/L and 388 +/- 59 pmol/L in aged patients with chronic bronchitis. It was found that dysfunction of small airway alone could cause remarkable elevation of PRA and AT II levels. In patients with mild pulmonary emphysema, the levels of PRA and AT II were significantly increased. The moderate pulmonary emphysema induced greatly increase of PRA, AT II and Ald levels. In patients with severe pulmonary emphysema, however, the plasma levels of PRA and AT II were significantly attenuated from the levels in moderate pulmonary emphysema while Ald level was still getting higher. There were no evidence to indicate the relationship between the changes of RAAS and hypoxemia., Conclusion: The elevation of AT II and PRA might partly be the pathogenesis of early pulmonary hypertension in COPD.

We measured plasma endogenous digitalis-like substances (EDLS), angiotensin II concentrations and plasma renin activity (PRA) by radioimmunoassay in 30 patients with pregnancy-induced hypertension (PIH), 30 normal pregnant women during the third trimester, and 23 non-pregnant women. Compared to the normal pregnant women, the concentration of plasma EDLS was significantly increased in patients with PIH (P < 0.05). There were significant positive correlations among plasma EDLS level, mean arterial pressure (r = 0.615; P < 0.01), the score index of PIH patients (r = 0.818; P < 0.01), hematocrit (r = 0.853; P < 0.01) and uric gravity (r = 0.764; P < 0.01). There was a significant negative correlation between plasma EDLS level and PRA in patients with PIH (r = -0.718; P < 0.01). Severe proteinuria and edema were related to a significant higher plasma EDLS level than the mild in patients with PIH (P < 0.001). After magnesium sulfate was administered in 9 severe patients of PIH, plasma EDLS levels were decreased (P > 0.05). These findings suggest that EDLS may play an important role in the pathogenesis of PIH and severe as an indicator of the severity of PIH. Its secretion may not be influenced after the administration of magnesium sulfate. There may be a close relationship between EDLS and renin-angiotensin system. When the medicine of digitalis type was administered in patients with PIH, the influence of EDLS must be considered to prevent digitalism.

Plasma renin activity (PRA), angiotensin II (AII), atrial natriuretic peptide (ANP) and AII/ANP were determined by radioimmunoassay in samples of blood from 59 burn patients. The results demonstrated that PRA, AII, ANP, AII/ANP increased significantly postburn. The increased level of AII/ANP correlated positively with the extent of burn injury as well as the severity of postburn renal dysfunction suggesting that the imbalance of AII and ANP played an important role in the pathogenesis of postburn renal damage.

Plasma concentrations of beta-endorphin (beta-EP), leucine enkephalin (LEK), arginine vasopressin (AVP), neurotensin (NT), renin activity (PRA) and angiotensin II (AT-II) were determined before and after the treatment with clonidine in 117 patients with essential hypertension. Before the treatment, the patient group had lower levels of beta-EP and LEK (P < 0.001), higher levels of AVP, PRA and AT-II (P < 0.05-0.01), as compared with those in control group. After 14 days of the treatment, plasma levels of beta-EP, LEK increased significantly (P < 0.001), and correlated negatively with the decrease of the mean artery pressure (r = -0.369 and r = -0.441, respectively, P < 0.01). PRA and AT-II decreased significantly (P < 0.05, P < 0.01). Decrease of AVP level was also observed, but did not reach the statistical significance. NT did not change both before and after the treatment. These data suggest that beta-EP and LEK may be involved in pathogenesis of hypertension and in hypotensive action of clonidine.

The antihypertensive and metabolic responses to delapril and captopril in hypertensive patients were studied. Forty-six hypertensive patients entered the study and were divided into two groups. The delapril group included 21 essential hypertensive and five renoparenchymal hypertensive patients; while the captopril group included 11 essential hypertensive and nine renoparenchymal hypertensive patients. The patients in the delapril group took delapril 7.5 mg twice a day for 2 weeks. If the antihypertensive effect was inadequate, the dose was increased to 15mg twice a day, and then to 30mg twice a day. The period of delapril treatment was 12 weeks. The patients in the captopril group took captopril 25 mg twice a day or three times a day for 12 weeks. After delapril treatment, there were significant decreases in the systolic (from 163 +/- 17 to 141 +/- 15 mmHg) and diastolic blood pressure (from 105 +/- 13 to 91 +/- 10 mmHg). There were also significant decreases in the systolic (from 161 +/- 18 to 141 +/- 24 mmHg) and diastolic blood pressure (from 100 +/- 10 to 90 +/- 12 mmHg) after captopril treatment (p < 0.001). The pulse rates in both groups showed no significant changes after treatment. The laboratory data in both groups showed few changes after treatment. Plasma renin activity increased after delapril treatment. A cough was the side effect most commonly seen. We conclude that hypertensive patients have the same blood pressure and metabolic responses to delapril as captopril.

68 urethan-anesthetized rabbits were prepared for registration of changes of respiration, arterial blood pressure (BP), heart rate (HR) and renal sympathetic nerve activity (RSNA) due to stimulation of area postrema (AP) by rectangular pulse trains each lasting for 4 s for every 30 s. During 40 min of such a stimulation paradigm the venous blood samples were collected for radioimmunoassay of plasma renin activity (PRA) (both pre- and post-stimulation), RSNA registered and processed by a computer. Animals were divided into three groups: (1) with AP stimulation only (n = 47); (2) AP stimulation after bilateral renal denervation (n = 13); (3) AP stimulation after propranolol injection (n = 8). In Group I, a 91% increase in PRA, an augmentation of RSNA, a rise of BP and a decrease of HR were observed, while respiration did not show obvious change. In Group II, hemodynamic and RSNA response was similar to that in Group I, but PRA was not changed significantly. In Group III, the effects on BP, HR, respiration and RSNA showed no remarkable changes compared with Group I, but significant inhibition of the response of PRA [from 0.65 +/- 0.07 ng/(ml.h-1) to 0.72 +/- 0.10 ng/(ml.h-1), P > 0.05] was observed. The results mentioned above suggested that electrical stimulation of AP may induce an increase in renin release and renal sympathetic nerve activity and hemodynamic changes in rabbits.

Twenty-eight patients with primary aldosteronism were treated from 1974 to 1990. The serum potassium concentration was higher than normal level in all patients with the exception of one whose serum potassium concentration was normal. All of 14 tested patients had low renin values. The plasma aldosterone concentration was higher than standard value in all of 5 patients, and the A/PRA ratio was more than 400. Spironolactone administered preoperatively could not only normalize serum potassium concentration level and blood pressure, but also predict postoperative prognosis of hypertension. Only 37.5% of adenomas were detected by retroperitoneal pneumography with tomography in the early period. 80.0% of adenomas were found by B-ultrasonography, and 92.8% by CT after 1982. The operation was done through abdominal incision because of indefinite localization of adenoma before 1982, and the operation was performed through lumbar incision because of definite localization of adenoma after 1982.

Acute volume loading produced by autogenous reinfusion of ascitic fluid provides an ideal volume expansion model for studying hormonal regulation and it was carried out in 10 cirrhotic patients with massive ascites. The basal plasma ANP level in the cirrhotic patients with ascites was 1776.00 +/- 160.72 ng/L, which was significantly elevated as compared with the level in normal controls (378.36 +/- 39.58 ng/L, P less than 0.01), PRA was significantly higher in patients with ascites (5.13 +/- 0.18 micrograms/l/h) than in healthy volunteers (1.46 +/- 0.31 micrograms/l/h, P less than 0.01). During reinfusion of ascitic fluid there was a significant natriuresis and diuresis; ANP rose from a basal mean value to a peak value of 2166.00 +/- 195.70 ng/l (P less than 0.05) at periinfusion. Subsequently, ANP dropped at 1 hour after infusion (1819.00 +/- 165.92ng/L, P less than 0.05), PRA dropped progressively from a mean basal level to that of 2.48 +/- 0.58 micrograms/l/h (P less than 0.05) at periinfusion. These data demonstrate that there is no evidence for absolute deficiency of ANP in cirrhosis with ascites. The immediate diuresis and natriuresis were associated with a rise in ANP, but the sustained renal consequences may be possibly connected with suppression of RAAS.

The plasma renin activity (RA), the concentration and the ratio of angiotensin (AI) conversion into angiotensin II (AII), and arginine vasopressin (AVP) level were observed in Wistar rats with pulmonary hypertension (PH) induced by extracardiac left-to-right shunting (LRS), hypobaric hypoxia (HH) and shunting plus HH (SHH). In comparison with normal control rats, RA in LRS and SHH rats showed an increasing trend, although no statistical significance appeared (P > 0.05). No change occurred in HH rats. The concentration and ratio of AI conversion into AII were significantly increased in LRS rats (P < 0.05), but decreased in HH and SHH rats (more markedly in HH rats). AVP increased significantly in LRS rats, and also showed an increasing trend in HH and SHH, but no significance was found (P > 0.05). The action of humoral factors in PH formation was discussed.

To evaluate the role of certain plasma biosubstances on the development of pulmonary hypertension and shock during severe hypoxia, hypercapnia and acidosis, plasma renin activity (PRA), angiotensin II (ATII), angiotensin converting enzyme (ACE), TXB2 and 6-Keto-PGF1 alpha (the stable metabolites of TXA2 and PGI2) were assayed in blood from pulmonary artery and aorta in seven pigs. Pulmonary arterial pressure (PAP) was monitored via Swan-Ganz catheter. During hypoxic and hypercapnic ventilation, PaO2 dropped to 4.7 kPa, PaCO2 rose to 21.1 kPa, pH dropped to 6.82, PAP increased from 2.43 +/- 0.06 to 4.46 +/- 0.45 kPa when acidotic shock developed (all P less than 0.05). Meanwhile ATII levels rose (all P less than 0.05). PRA significantly increased during acidotic shock as compared with normal ventilation (P less than 0.02). ACE dropped significantly (P less than 0.05), TXB2 and 6-keto-PGF1 alpha showed no significant change before and after hypoxic and hypercapnic ventilation.

Safflower yellow (SY) is a mixture of chalconoid compounds extracted from Carthamus tinctorius L. Ig SY 1-2 g.kg-1.d-1 lowered the blood pressure of spontaneously hypertensive rats (SHR), for about 1.86-3.86 kPa. Five weeks after administration of SY, the plasma renin activity and angiotensin II level diminished in the SHR experimental groups. These suggest that the decrease of blood pressure is mediated by the renin-angiotensin system.

A serial measurements of plasma renin activity (PRA), serum angiotensin converting enzyme activity (ACE), concentrations of plasma angiotensin II (AII) and plasma aldosterone (Ald) in 38 consecutive patients with acute myocardial infarction (AMI) or suspected AMI showed that PRA, AII and Ald levels increased in patients with AMI, especially within first week after onset, and were significantly higher in those cases with severe complications. ACE kept in normal range in all subjects. After small dose captopril therapy, ACE and Ald decreased significantly, PRA and AII increased in 6 patients with AMI. Small dose captopril could cause remarkable blood pressure reduction, but no effect on heart rate. The results suggested that renin-angiotensin-aldosterone system was activated during AMI, especially in cases with severe complications. Captopril could inhibit this system partially.

130 cases of patients with essential hypertension (EH) and 70 cases of normal subjects were researched for correlation between TCM differential types and plasma levels of renin, angiotension II, aldosterone, atrial natriuretic factor (ANF) in patients with EH. Results indicated that: (1) basic level of renin was lower in patients with EH than that in normal subject. There were significant differences of plasma levels of renin between different TCM types. Plasma renin level of excessive Yang patients was higher than that in normal subject group and groups of deficiency of Yin essence combined with excessive Yang as well as deficiency of both Yin and Yang (P less than 0.01-0.001). Plasma level of angiotension II was significantly higher in group of excessive Yang than that in normal subject and other two groups (P less than 0.01-0.001). It was indicated that there were correlation between plasma basic level of renin, angiotension II and TCM types. (2) Plasma ANF level in patients with EH was significantly lower than that in group of normal subject (P less than 0.01). There were significant differences between groups of three different TCM types (P greater than 0.05). The result suggested that lower plasma ANF level was general character in three groups with EH. The prognosis of these patients was discussed.

To investigate the relationship between renin-angiotensin-aldosterone system and pulmonary hemodynamic parameters in patients with chronic pulmonary artery hypertension, we measured plasma levels of renin activity, angiotensin II and aldosterone in 11 patients during right heart catheterization. All patients had chronic obstructive pulmonary disease. At rest, plasma concentration of angiotensin II positively correlated with mean pulmonary artery pressure (r = 0.76, P less than 0.01) and pulmonary vascular resistance (r = 0.64, P less than 0.05). During exercise, plasma level of angiotensin II increased from 70 +/- 21 to 81 +/- 24 pg/ml (P less than 0.01) and plasma renin activity from 0.66 +/- 0.54 to 1.28 +/- 1.2 ng/ml/h (P less than 0.05), whereas mean pulmonary artery pressure increased from 3.73 +/- 0.85 to 6.27 +/- 1.81 kPa (28 +/- 6.4 to 47 +/- 13.6 mmHg). Increase of angiotensin II correlated with changes in mean pulmonary artery pressure (r = 0.69, P less than 0.05) but not with systemic artery pressure. The results of present study suggest that angiotensin II might play a role in the development of pulmonary artery hypertension in patients with chronic obstructive pulmonary disease.