Vasopressin and Blood Pressure in Humans
2000; Lippincott Williams & Wilkins; Volume: 36; Issue: 6 Linguagem: Inglês
10.1161/01.hyp.36.6.e3
ISSN1524-4563
AutoresJens Jordan, Jens Tank, André Diedrich, David Robertson, J. R. Shannon,
Tópico(s)Anesthesia and Neurotoxicity Research
ResumoHomeHypertensionVol. 36, No. 6Vasopressin and Blood Pressure in Humans Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBVasopressin and Blood Pressure in Humans Jens Jordan and Jens Tank Andre Diedrich, David Robertson and John R. Shannon Jens JordanJens Jordan Clinical Research Center, Franz Volhard Klinik, Charite, Humboldt University, Berlin, Germany and Jens TankJens Tank Clinical Research Center, Franz Volhard Klinik, Charite, Humboldt University, Berlin, Germany Andre DiedrichAndre Diedrich Nathan Blaser Shy-Drager Research Program, Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee , David RobertsonDavid Robertson Nathan Blaser Shy-Drager Research Program, Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee and John R. ShannonJohn R. Shannon Nathan Blaser Shy-Drager Research Program, Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee Originally published1 Dec 2000https://doi.org/10.1161/01.HYP.36.6.e3Hypertension. 2000;36:e3–e4To the Editor:The importance of vasopressin for blood pressure regulation in humans has been a matter of debate for the past few decades. In healthy subjects, pharmacological blockade of vascular vasopressin (VI) receptors leads to no or minimal changes in arterial blood pressure.1 This observation suggests that in the presence of intact function of the autonomic nervous system and the renin-angiotensin-aldosterone system, vasopressin release may be of minor importance for the maintenance of blood pressure. However, with impaired autonomic nervous system function or renin-angiotensin-aldosterone system function, vasopressin release may serve as a back-up mechanism to prevent excessive hypotension. For example, the hypotension in vasovagal syncope and pure autonomic failure23 and during ganglionic blockade45 is associated with a substantial increase in plasma vasopressin concentration. In this study, we applied short hypotensive stimuli during ganglionic blockade to further elucidate the role of vasopressin in blood pressure regulation in humans.We studied 10 healthy subjects (5 men, 5 women, 33±1.9 years). In all studies, the heart rate was determined by continuous electrocardiogram and the blood pressure was measured by a radial artery catheter. In an initial study, 7 subjects underwent a battery of cardiovascular autonomic reflex tests before and during complete blockade of autonomic ganglia with trimethaphan.5 Before ganglionic blockade, the respiratory sinus arrhythmia ratio was 1.4±0.09. Blood pressure increased 26±4/21±3.7 and 34±1.5/26±2.0 mm Hg with sustained handgrip and cold pressor testing, respectively. Blood pressure did not decrease from baseline during phase 2 of the Valsalva maneuver (40 mm Hg intrathoracic pressure for 15 seconds), but blood pressure increased 19±4.8/12±3.0 mm Hg above the baseline value during phase 4.With ganglionic blockade, blood pressure decreased from 129±4.3/67±3.2 mm Hg to 94±4.5/52±2.2 mm Hg and the plasma norepinephrine concentration decreased from 190±27 pg/mL to 39±8.3 pg/mL (P<0.01). Plasma renin activity did not change despite the profound decrease in blood pressure. Plasma vasopressin concentration was 1.6±0.13 pg/mL at baseline and increased to 27±15 pg/mL during ganglionic blockade (P 3 minutes in all subjects.In a subsequent study in 6 subjects, we tested the hypothesis that this delayed pressor response in the absence of autonomic nervous system function might be related to a release of catecholamines or vasopressin or to an increase in plasma renin activity. During trimethaphan infusion, which was at a stable rate for at least 60 minutes to allow for the stabilization of neurohumoral mechanisms, venous blood samples were obtained. Study subjects then performed the Valsalva maneuver for 15 seconds. Venous blood was again obtained 90 seconds after completion of the maneuver. Blood pressure decreased profoundly during phase 2, and the blood pressure overshoot during phase 4 was absent (Figure, top). Blood pressure increased from 98±3.5/55±1.8 mm Hg at baseline to a maximum of 114±5.1/66±4.6 mm Hg 125±20 seconds after the completion of the Valsalva maneuver (P<0.05). Plasma vasopressin concentration increased 3-fold, from 16±5.4 pg/mL before the Valsalva maneuver to 49±9.5 pg/mL 90 seconds after the Valsalva maneuver (P<0.05) (Figure, bottom). In contrast, plasma renin activity and plasma catecholamines did not change.We conclude that in some normal subjects, acute hypotension during ganglionic blockade is followed by a delayed and sustained pressor response. The temporal association of the delayed pressor response and vasopressin release suggests that vasopressin contributes to blood pressure control in humans in the setting of impaired autonomic nervous system function. Assessment of vasopressin release during ganglionic blockade provides a unique tool to characterize afferent and central parts of the baroreflex that are not accessible with conventional baroreflex tests.Dr. Jordan is supported by the Deutsche Forschungsgemeinschaft.Download figureDownload PowerPoint Figure 1. Figure. (top) Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) before, during, and after a Valsalva maneuver that was conducted during complete ganglionic blockade. During phase II of the Valsalva maneuver (II), blood pressure decreased profoundly. The neurally mediated blood pressure overshoot during phase IV was absent. Baroreflex-mediated heart rate changes were abolished. After the Valsalva maneuver, blood pressure increased markedly. (bottom) Plasma vasopressin concentration before and after the Valsalva maneuver. After the Valsalva maneuver, plasma vasopressin concentration increased markedly in each subject. References 1 Bussien JP, Waeber B, Nussberger J, Schaller MD, Gavras H, Hofbauer K, Brunner HR. Does vasopressin sustain blood pressure of normally hydrated healthy volunteers? Am J Physiol.1984; 246:HI43–HI47.Google Scholar2 Kauftnann H, Oribe E, Miller M, Knott P, Wiltshire-Clement M, Yahr MD. Hypotension induced vasopressin release distinguishes between pure autonomic failure and multiple system atrophy with autonomic failure. Neurology.1992; 42:590–593.CrossrefMedlineGoogle Scholar3 Zerbe RL, Henry DP, Robertson GL. Vasopressin response to orthostatic hypotension: etiologic and clinical implications. Am J Med.1983; 74:265–271.CrossrefMedlineGoogle Scholar4 Baylis PH, Robertson GL. Osmotic and non-osmotic stimulation of vasopressin release [Proceedings]. J Endocrinol.1979; 83:39P–40P.MedlineGoogle Scholar5 Jordan J, Shannon JR, Black BK, Lance RH, Squillante MD, Costa F, Robertson D. Nn-nicotinic blockade as an acute human model of autonomic failure. Hypertension. 1998;31;1178–1184Google Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hoenemann J, Moestl S, van Herwaarden A, Diedrich A, Mulder E, Frett T, Petrat G, Pustowalow W, Arz M, Heusser K, Lee S, Jordan J, Tank J and Hoffmann F (2023) Effects of daily artificial gravity training on orthostatic tolerance following 60-day strict head-down tilt bedrest, Clinical Autonomic Research, 10.1007/s10286-023-00959-5, 33:4, (401-410), Online publication date: 1-Aug-2023. Manuel J, Färber N, Gerlach D, Heusser K, Jordan J, Tank J and Beissner F (2020) Deciphering the neural signature of human cardiovascular regulation, eLife, 10.7554/eLife.55316, 9 Jordan J, Ricci F, Hoffmann F, Hamrefors V and Fedorowski A (2020) Orthostatic Hypertension, Hypertension, 75:5, (1151-1158), Online publication date: 1-May-2020.Baker S, Limberg J, Dillon G, Curry T, Joyner M and Nicholson W (2018) Aging Alters the Relative Contributions of the Sympathetic and Parasympathetic Nervous System to Blood Pressure Control in Women, Hypertension, 72:5, (1236-1242), Online publication date: 1-Nov-2018. Sosnowski P, Zera T, Wilenska B, Szczepanska‐Sadowska E and Misicka A (2015) Imaging and identification of endogenous peptides from rat pituitary embedded in egg yolk, Rapid Communications in Mass Spectrometry, 10.1002/rcm.7112, 29:4, (327-335), Online publication date: 28-Feb-2015. Jordan J (2014) CrossTalk opposing view: Which technique for controlling resistant hypertension? Carotid sinus stimulation, The Journal of Physiology, 10.1113/jphysiol.2013.268078, 592:18, (3933-3935), Online publication date: 15-Sep-2014. Thiele R and Isbell J (2014) Vasopressors and inotropes Perioperative Hemodynamic Monitoring and Goal Directed Therapy, 10.1017/CBO9781107257115.012, (85-94) (2014) Cardiovascular Physiology Applied to the Perioperative and Critical Care Settings Perioperative Hemodynamic Monitoring and Goal Directed Therapy, 10.1017/CBO9781107257115.006, (29-106) Barnes J, Hart E, Curry T, Nicholson W, Eisenach J, Wallin B, Charkoudian N and Joyner M (2013) Aging Enhances Autonomic Support of Blood Pressure in Women, Hypertension, 63:2, (303-308), Online publication date: 1-Feb-2014. Jordan J and Biaggioni I (2012) Genetic influences on human baroreflex regulation, Autonomic Neuroscience, 10.1016/j.autneu.2012.10.011, 172:1-2, (23-25), Online publication date: 1-Dec-2012. Jordan J, Heusser K, Brinkmann J and Tank J (2012) Electrical carotid sinus stimulation in treatment resistant arterial hypertension, Autonomic Neuroscience, 10.1016/j.autneu.2012.10.009, 172:1-2, (31-36), Online publication date: 1-Dec-2012. Piazza O, Scarpati G, Rispoli F, Iannuzzi M, Tufano R and De Robertis E (2012) Terlipressin in brain‐death donors, Clinical Transplantation, 10.1111/ctr.12038, 26:6, Online publication date: 1-Nov-2012. Koshimizu T, Nakamura K, Egashira N, Hiroyama M, Nonoguchi H and Tanoue A (2012) Vasopressin V1a and V1b Receptors: From Molecules to Physiological Systems, Physiological Reviews, 10.1152/physrev.00035.2011, 92:4, (1813-1864), Online publication date: 1-Oct-2012. Frouget T (2012) Syndrome d'antidiurèse inappropriée (sécrétion inappropriée d'hormone antidiurétique), La Revue de Médecine Interne, 10.1016/j.revmed.2012.07.005, 33:10, (556-566), Online publication date: 1-Oct-2012. Wagener G, Gubitosa G, Renz J, Kinkhabwala M, Brentjens T, Guarrera J, Emond J, Lee H and Landry D (2008) Vasopressin decreases portal vein pressure and flow in the native liver during liver transplantation, Liver Transplantation, 10.1002/lt.21602, 14:11, (1664-1670), Online publication date: 1-Nov-2008. Christou D, Parker Jones P, Pimentel A and Seals D (2004) Increased abdominal-to-peripheral fat distribution contributes to altered autonomic-circulatory control with human aging, American Journal of Physiology-Heart and Circulatory Physiology, 10.1152/ajpheart.00322.2004, 287:4, (H1530-H1537), Online publication date: 1-Oct-2004. Delmas A, Leone M, Rousseau S, Albanèse J and Martin C (2003) Place de la vasopressine chez les patients en choc septique, Annales Françaises d'Anesthésie et de Réanimation, 10.1016/S0750-7658(03)00210-7, 22:7, (600-608), Online publication date: 1-Jul-2003. Abbott K and Bakris G (2002) Chapter 23 Treatment of the diabetic patient: focus on cardiovascular and renal risk reduction Vasopressin and Oxytocin: From Genes to Clinical Applications, 10.1016/S0079-6123(02)39025-3, (289-298), . Herrera V and Ruiz-Opazo N (2001) Identification of a Novel V1-type AVP Receptor Based on the Molecular Recognition Theory, Molecular Medicine, 10.1007/BF03401855, 7:7, (499-506), Online publication date: 1-Jul-2001. December 2000Vol 36, Issue 6 Advertisement Article InformationMetrics https://doi.org/10.1161/01.HYP.36.6.e3 Originally publishedDecember 1, 2000 PDF download Advertisement
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