CLINICAL EVALUATION OF 1-SARCOSINE, 8-ISOLEUSINE ANGIOTENSIN II TEST ON RENOVASCULAR HYPERTENSION

Abstract

Recently, some angiotensin II analogues have been reported as competitive inhibitors for angiotensin II in renin dependent hypertension. 1-Sar, 8-Ile, angiotensin II, which is reported to have the strongest action among the angiotensin II analogues, was administrated, pre-and post-operatively, to 3 cases of renovascular hypertension, one case of hypertension due to remarkable unilateral hydronephrosis, malignant hypertension and hypertension with chronic glomerulonephritis.
In this article, we designed to study the relationship between the kinds of hypertension related to plasma renin activity and response of blood pressure to 1-Sar, 8-Ile, angiotensin II, and to study whether this drug is used as a diagnostic aid or for decision of operative indication for renovascular hypertension.
Under non-limited diet, or low-salt (NaCl: under 3.0g per day) diet and furosemide 120mg per day for 3 days, 1-Sar, 8-Ile, angiotensin II was administrated, dissolved in normal saline. When the blood pressure was decreased more over than 20mmHg systolic or 10mmHg diastolic by this drug, the response was judged to be positive.
Two cases of renovascular hypertension, which had high peripheral plasma renin activity and lateralizing renal vein renin ratio, showed positive response to 1-Sar, 8-Ile, angiotensin II. The rest 2 cases of renovascular hypertension, of which one had high peripheral plasma renin activity increasing into abnormal high range by stimmulation, showed a positive blood pressure response after decreasing of total plasma volume by low-salt diet and furosemide administration, though they presented a negative blood pressure response under normal diet or normal condition.
Isolateral nephrectomy, resection of stricture portion and end-to-end anastomosis of renal artery, and bypass formation between the aorta and normal renal artery, using auto-saphenous vein, were performed on each of 4 cases, and normalization of blood pressure were observed in all cases. Post operative 1-Sar, 8-Ile, angiotensin II infusion tests revealed a negative response in all 4 cases of renovascular hypertension.
We concluded that 1-Sar, 8-Ile, angiotensin II infusion tests revealed the contributory degree of renin-angiotensin system in renovascular hypertension and this test was available for decision of operative indication or judgement of operative effect.
Although the blood pressure response was positive in the case of malignant hypertension, transiently incresed blood pressure with slight headache was observed due to the agonistic action of this drug in the case of hypertension with chronic glomerulonephritis whose plasma renin activity was normal in spite of renin secretion stimmulation.
To the remarkable hypertension following pyeloplastic operation in the case of hypertension due to hydronephrosis presenting high plasma renin activity, 1-Sar, 8-Ile, angiotensin II was administrated continuously for 28hours. The blood pressure decreased to almost normal and the patient was releaved from the dangerous state. Thus, 1-sar, 8-Ile, angiotensin II also could be used as a therapeutic aid in such a particular condition as hypotonics.