Glucocorticoids and hypertension in man

Abnormalities of cortisol production or metabolism are involved in the genesis of hypertension in Cushing's syndrome, apparent mineralocorticoid excess and liquorice abuse and possibly in chronic renal failure and essential hypertension. We have studied the physiological mechanisms by which cortisol raises blood pressure in short term studies of cortisol administration in normal men. Cortisol induced hypertension cannot be explained by increases in vasopressor or decreases in vasodepressor hormone concentrations, or by any increase in sympathetic nervous activity. The hypertension is accompanied by substantial sodium retention but a significant component of the blood pressure rise is sodium independent. The hypertension is characterized by an increase in cardiac output but a rise in output is not essential for the rise in blood pressure. Our working hypothesis is that cortisol induced hypertension is a consequence of increases in renal vascular resistance.

Effects of diet on measurement of nitric oxide metabolites

1. The present study investigated whether a low nitrate/nitrite diet could minimize variability in the measurement of endogenous plasma and urine nitric oxide (NO) metabolites, nitrate and nitrite (NOx) in normal subjects. 2. Nitrate and nitrite concentrations were measured in plasma and urine as indicators of NO production in six subjects during a free diet and then during a low nitrate/nitrite diet for 6 days. 3. The plasma concentration and 24 h urine NOx/creatinine ratio were significantly lower on the low nitrate/nitrite diet than on the free diet (P < 0.01). Nitric oxide production appeared to vary greatly within and between subjects, but these variations were substantially decreased by the fourth day of a low nitrate/nitrite diet. 4. Human plasma and urine NOx measurements should be determined after a low nitrate/nitrite diet for at least 4 days.

Reflex sympathetic function in cortisol-induced hypertension in humans

Nine healthy male subjects underwent measurement of reflex sympathetic function, pressor responsiveness and baroreflex sensitivity to phenylephrine (PE) and glyceryltrinitrate (GTN) before (C1) and following six days of treatment (E6) with cortisol (F), 200 mg/day. Seven subjects had washout studies (W) performed at least two weeks following the end of treatment. The BP responses to head tilt, isometric exercise and mental arithmetic were unaltered by F, however, there was a significant diminution of the diastolic BP response to cold pressor stimulus (delta DBP: 19 +/- 3 vs 25 +/- 5 vs 27 +/- 5 mmHg; E6 vs C1 vs W, p < 0.05 C1 vs E6 and W). Baroreflex sensitivity to PE was increased (28 +/- 3 vs 19 +/- 2 ms/mmHg, E6 vs C1, p = 0.03). These data demonstrate that increased BP during F treatment is not attributable to increased SNS activity, and suggest that SNS activity may be decreased by F.

The role of the hypothalamic-pituitary-adrenal (HPA) axis in the regulation of blood pressure

The role of the HPA axis in blood pressure regulation was examined in 6 normal male volunteers by comparing haemodynamic and hormonal effects of placebo, captopril, and dexamethasone given in random order for two days. The average 24-hour systolic and mean arterial pressures on placebo (135 +/- 6 and 93 +/- 2 mmHg respectively) were significantly higher than on captopril (118 +/- 1 and 85 +/- 1 mmHg respectively, p < 0.05) but there were no significant changes on dexamethasone compared with placebo (128 +/- 3 and 89 +/- 3 mmHg respectively). There were no differences in the average 24-hour diastolic blood pressures or heart rates, nor the day-night differences, night:day ratios or percentage changes in blood pressure and heart rate between treatments. Captopril significantly increased active plasma renin concentration, whilst dexamethasone decreased cortisol concentration. These results confirm the role of the renin-angiotensin system in the regulation of blood pressure in normal subjects but suggest that the HPA axis does not play a major role in determining ambulatory blood pressure or day-night variability in the short term.

An HIV-1 natural history cohort and survival times in rural Uganda

OBJECTIVE

To describe a population-based rural cohort of HIV-1-seropositive and seronegative individuals established in 1990 in south-west Uganda, and determine survival times in the cohort.

DESIGN

Prospective cohort study.

METHODS

Participants were recruited from a large population study, and invited to attend a clinic every 3 months. They were seen by clinicians who administered detailed medical questionnaires and undertook a physical examination.

RESULTS

By the end of 1995, 390 (79%) of the 491 people asked to enrol in the natural history cohort (NHC) had done so. Ninety-three were prevalent cases of HIV infection detected during the initial survey round of the general population cohort in 1989/1990, 66 were subsequent incident cases, 177 were age-matched HIV-negative controls and 54 were HIV-negative spouses of HIV-positive individuals. Twenty participants seroconverted in the NHC. The age-standardized mortality rates per 1000 person-years for the prevalent, incident, and negative cases were 156.5 [95% confidence interval (CI), 115.8-211.4], 35.0 (95% CI, 16.4 75.0) and 13.5 (95% CI, 7.3-25.1), respectively. The median survival time from enrolment to death for the prevalent cases was 4.5 years (95% CI, 3.5- > 5.2); > 5.4 years from seroconversion for the incident cases; and > 5.2 years from enrolment for the HIV-negative cases. The 5-year cumulative survival for prevalents, incidents and HIV-negative participants was 46%, 83% and 94%, respectively.

CONCLUSIONS

We have described an NHC of HIV-positive and HIV-negative participants which is representative of the general population. The NHC was established over 5 years ago; it is continuing and we are maintaining good compliance rates. Survival probabilities in the cohort were lower than most other reported studies.

Hemodynamic effects of the Fab fragment of digoxin antibody (digibind) in corticotropin (ACTH)-induced hypertension

To determine whether the immune Fab fragment of digoxin antibody (digibind) attenuates established corticotropin (ACTH) hypertension, rats were given ACTH sham control (0.1 mL normal saline, twice daily, subcutaneously, n = 18) or ACTH treatment (2.5 microg/kg in 0.1 mL normal saline, twice daily, subcutaneously; n = 27) for 10 days. Acute hemodynamic effects of digibind (30 mg/kg, intravenous bolus injection) were examined after 10 days of sham control or ACTH treatment. Rats were divided into 7 groups: digibind (30 mg/kg, in 1 mL 0.9% NaCl intravenous bolus injection) plus sham (n = 6) or ACTH (n = 8), sham digibind (1 mL 0.9% NaCl intravenous bolus) plus ACTH (n = 7), digibind vehicle (sorbitol 1.8 mg in 1 mL 0.9% NaCl, intravenous bolus) plus sham (n = 6), preimmune sheep IgG (30 mg/kg in 1 mL 0.9% NaCl intravenous bolus) plus sham (n = 6) or ACTH (n = 6) and preimmune sheep IgG (Fab)2 fragment (30 mg/kg in 1 mL 0.9% NaCl intravenous bolus) plus ACTH (n = 6). ACTH increased systolic blood pressure (SBP) from 118 +/- 2 to 132 +/- 3 mm Hg on treatment day 10. BP was unchanged in sham treated rats. The acute administration of digibind decreased MAP (-14 +/- 3 mm Hg, P <.001) in ACTH hypertensive rats, but not in ACTH sham control normotensive rats (+2 +/- 3 mm Hg). Blood pressure reached a minimum after 14 +/- 3 min and the effect lasted more than 30 min. No significant change of blood pressure was found in ACTH treated rats receiving sham (0.9% NaCl) digibind injection (+2 +/- 2 mm Hg). However, both preimmune sheep IgG and IgG (Fab)2 fragment caused a decrease of blood pressure in both sham or ACTH treated rats. Although these data that digibind decreases BP in ACTH but not sham treated rats are consistent with the notion that digitalis-like substances may play a role in ACTH induced hypertension, the evidence that both preimmune sheep IgG and IgG (Fab)2 fragments also decreased blood pressure in rats suggests caution in interpretation of studies that employ digibind preparations.

Autonomic blockade amplifies cortisol-induced hypertension in man

1. We investigated the role of the autonomic nervous system (ANS) in cortisol induced hypertension using the technique of total autonomic blockade (AB). 2. Four healthy young males were given 50 mg cortisol 6 hourly for 6 days. On the day prior to, and the last day of, cortisol treatment, AB was produced using oral prazosin 1 mg, intravenous clonidine 300 micrograms, propranolol 0.2 mg/kg and atropine 2 mg. The adequacy of blockade was assessed using the haemodynamic response to Valsalva manoeuvre. 3. Cortisol produced a significant rise in systolic blood pressure (130 +/- 2 vs 110 +/- 1 mmHg, pre vs post cortisol; P < 0.01). On the final treatment day, AB augmented the increase in diastolic blood pressure (delta DBP), mean arterial pressure (delta MAP) and heart rate (delta HR) compared to the pretreatment day, delta DBP: 43 +/- 6 vs 17 +/- 4 mmHg, post vs pre cortisol, P < 0.005, delta MAP: 39 +/- 4 vs 14 +/- 4 mmHg, P < 0.001, delta HR: 45 +/- 5 vs 26 +/- 4 b.p.m., P < 0.05. The change in systolic blood pressure (delta SBP) was not statistically significant (32 +/- 4 vs 7 +/- 3 mmHg, P = 0.065). 4. These results suggest that the ANS exerts a modulating influence on the hypertensive effect of cortisol.

Clinical and parasitological responses after up to 6.5 years of ivermectin treatment for onchocerciasis

There are plans to use mass treatment with ivermectin to clear all Africa of the worst ocular and cutaneous effects of onchocerciasis. However, there remains uncertainty about the most suitable treatment regimen and the likely effects of ivermectin on onchocercal skin disease. We have followed 948 subjects for over 6 years in a double-blind, randomized, controlled study of ivermectin for onchocerciasis in a hyperendemic focus in Sierra Leone. Using an intention-to-treat analysis we found a microfilarial prevalence of 16% 6 months after up to 4 annual doses of ivermectin, and 13% prevalence in the group receiving up to 10 doses of ivermectin at 6-monthly intervals. Microfilarial loads were well suppressed in both groups, but repopulation data suggest that adult female worms are still alive and fecund, strongly underlining the need to continue treatment. A clear effect of ivermectin was demonstrated on itching, with about one-third of cases being alleviated. Significant reductions in the prevalence of serious hyperkeratosis, and possibly dyspigmentation (leopard skin), were noted, but not for any other onchocercal skin lesion. Six-monthly and annual treatment regimens with ivermectin were equally effective in terms of dermatological and parasitological impact.

Dose-response relationships and mineralocorticoid activity in cortisol-induced hypertension in humans

OBJECTIVE

This study was designed to define the dose-response relationships for cortisol-induced hypertension in humans and to test the hypothesis that cortisol-induced hypertension is a consequence of classical mineralocorticoid actions using the mineralocorticoid antagonist spironolactone.

METHODS

In study 1, six normal men were given cortisol orally every 6 h for 5 days at doses of 40, 80 and 200 mg per day. In study 2, six normal men were given spironolactone at 400 mg/day for 6 days and cortisol at 80 mg/day for 5 days, commencing on the second day of spironolactone treatment.

RESULTS

Systolic blood pressure increased significantly with cortisol at 80 and 200 but not 40 mg/day. There was no difference between 80 and 200 mg/day. Weight increases were seen at the two higher doses and serum potassium concentration fell with each dose. Spironolactone prevented the increase in body weight and the decrease in serum potassium but did not affect the increase in blood pressure produced by cortisol.

CONCLUSIONS

Cortisol at 80 and 200 mg per day produces similar blood pressure and metabolic effects. Spironolactone blocked the mineralocorticoid effects of cortisol but not the blood pressure rise, suggesting that these mineralocorticoid effects are not responsible for cortisol-induced hypertension.

Ambulatory blood pressure monitoring (ABPM) in the normal menstrual cycle and in women using oral contraceptives. Comparison with conventional blood pressure measurement

This study was undertaken to determine if blood pressures (BP) assessed by routine sphygmomanometry and 24 h ambulatory monitoring (ABPM) alter throughout the normal menstrual cycle or in the cycle of women using oral contraceptive pills (OCP), and the interrelationships between urinary sodium (Na) and potassium (K) excretion and ABPM throughout the menstrual cycle. Eleven women with a normal ovulatory cycle (ovulatory) and ten age-matched women taking an oral contraceptive pill (OCP) were studied three times in random order during their menstrual cycle, within days 1 to 5, 13 to 16, and 25 to 28. Twenty-four hour urine Na, K, and creatinine (Cr) excretion and serum Na, K, Cr, cortisol, estradiol, progesterone and plasma renin, angiotensinogen, and aldosterone concentrations were measured. BP was measured by a mercury sphygmomanometer and by 24 h BP (Accutracker II). On days 1 to 5, daytime systolic BP was higher in OCP [mean: 123 mm Hg, 95% confidence interval: 117, 128] than ovulatory women [114 mm Hg (109, 118); P = .011] though daytime diastolic BPs were similar [OCP: 71 (68, 75), ovulatory: 69 (66, 72)]. This difference in daytime systolic BP between groups was also apparent at both of the other stages of the menstrual cycle. Nighttime systolic BPs were significantly higher in OCP users on days 13 to 16 (P < .05) and days 25 to 28 (P < .01). In women taking OCPs, daytime ABPM for days 1 to 5 were higher than their office readings by 15 (7,23)/11 (7,15) mm Hg (P = .001), whereas office and ABPM readings were similar in ovulatory women. This pattern was evident at all three stages. There was no significant change in BP throughout the menstrual cycle within either group, and no correlation between urine Na or K and BP. Systolic BPs are higher throughout the menstrual cycle in women who take OCPs than in ovulatory women but this difference is only detected when ambulatory blood pressure is assessed. Blood pressure does not change subsequently in either ovulatory or OCP-taking women throughout the menstrual cycle.

Viability and fertility of adult Onchocerca volvulus after 6 years of treatment with ivermectin

Onchocerca volvulus nodules were removed from 77 fully compliant patients in a longitudinal study of ivermectin treatment in Sierra Leone. The patients had participated in a randomized controlled trial and received either 4 annual doses of ivermectin or 10 6-monthly doses over 6 years. Worms were examined 9 months after the last treatment for evidence of changes in morphology, viability and reproductivity. The findings were compared with results for the 2 groups obtained at earlier surveys of the same study population. Repeated treatment at 6 and 12-month intervals has resulted in a marked ageing of the male worm population profile and a significant reduction in the proportion of live female worms found in the nodules. In addition, there has been a reduction in reproductivity of 90% or more. However, most of the worms found were still alive and potentially fertile, underlining the need for the continuation of regular ivermectin treatment to maintain the benefits achieved.

Maintaining compliance to ivermectin in communities in two West African countries

We have investigated various aspects related to managing wide-scale ivermectin distribution schemes within randomized controlled trials in communities where onchocerciasis is endemic. Multiple logistic regression analysis of determinants of compliance to five doses of ivermectin in 589 people in Sierra Leone showed independent significant associations with leopard skin depigmentation, the severity of side effects of treatment, fulfilling the exclusion criteria for treatment, and long-term residence in the community. These results are useful for tailoring health promotion messages in Sierra Leone, but the associations may differ in other West African societies. In Nigeria 1847 people were interviewed about various subjective responses, including itching. None of these showed clear improvement after three years of ivermectin treatment. Positive comments about treatment were generally non-specific and similar in the placebo and ivermectin groups. Negative comments were usually related to adverse reactions, especially itching and rash, and were more common after ivermectin. The lack of any benefit attributable to ivermectin that is discernible to its recipients may make it difficult to maintain the high compliance rates needed for long periods if mass dosing programmes are to have a lasting impact on onchocerciasis. In addition, no consistent effects of ivermectin were found by measuring visual acuity, height, weight or haematocrit in comparison with placebo. This may indicate that evidence of clinical impact is very slow to develop and is hard to measure using simple objective methods after only three doses of treatment. At present it seems that parasitological, entomological and detailed ophthalmological or dermatological methods are required to demonstrate the impact of ivermectin treatment in the medium-term.

Primary hyperaldosteronism: a missed diagnosis in 'essential hypertensives'?

BACKGROUND

It has been recognised recently that primary hyperaldosteronism may be more common than previously thought, the frequency of diagnosis being improved by screening using a plasma aldosterone concentration to renin activity ratio.

AIMS

To determine the frequency of primary hyperaldosteronism, screening with both plasma aldosterone to renin concentration (PRC) and activity (PRA) ratios, in normokalaemic subjects previously diagnosed as having essential hypertension.

METHODS

Plasma potassium, aldosterone and PRCs and PRA and blood pressure (BP) were measured in 74 hypertensive subjects previously diagnosed by one physician as having essential hypertension. A normal range for plasma aldosterone/renin ratios was determined in 147 control subjects. Hypertensive subjects with elevated aldosterone/renin ratios were further assessed for primary hyperaldosteronism using saline loading and fludrocortisone suppression. Those in whom plasma aldosterone concentration exceeded 140 pmol/L after suppression tests underwent adrenal vein sampling for measurement of aldosterone and cortisol concentrations as well as adrenal CT scanning to diagnose the cause of primary hyperaldosteronism. The main outcome measures were a diagnosis of aldosterone producing adenoma or bilateral adrenal hyperplasia based upon adrenal vein sampling.

RESULTS

Four subjects (5%) had an elevated plasma aldosterone to renin ratio using PRC and six (8%) using PRA. Two subjects (2.7%) in this selected population had primary hyperaldosteronism, both of whom had BP > 160/110 mmHg at the time of testing.

CONCLUSIONS

The frequency of normokalaemic primary hyperaldosteronism appears to be greater than previously thought, though the true incidence in the general population of hypertensive subjects remains unknown. The sensitivity of diagnosis (but not specificity) may be improved by measurement of the plasma aldosterone/renin ratio and PRC is at least as adequate as PRA for this process.

Human isotype antibody responses to an Onchocerca volvulus glutathione S-transferase

Human isotype specific antibody responses to a recombinant pi-class glutathione S-transferase (Ov24) from Onchocerca volvulus were assessed by ELISA, using a large and well-characterized bank sera (n = 238) from an hyper-endemic area of moderate intensity from Sierra Leone. IgG1, IgG4 and IgA responses, but neither IgG2 nor IgE response, to Ov24 were detected in infected subjects. The relationships between Ov24 antibody levels and skin microfilarial density, number of nodules, age, sex, eosinophil counts and clinical sign of reactive and chronic pathology were analysed using Pearson's correlation coefficient. Significant correlations between both IgA and IgG3 antibody levels and age were found (P < 0.01). Although no firm conclusions could be drawn from this study sample regarding the relationships between antibody levels and parasite load or clinical status, a negative correlation (P = 0.06) between Ov24 IgG3 antibody levels and microfilarodermia was found.

The effects of multiple doses of ivermectin on ocular onchocerciasis. A six-year follow-up

BACKGROUND

Ivermectin has been shown to be a safe treatment for onchocerciasis and is now being distributed through mass treatment programs. Previous studies of up to 3 years of treatment have demonstrated that ivermectin improves anterior segment lesions and reduces the incidence of optic atrophy. The benefit of multiple doses of ivermectin on visual acuity and chorioretinitis has yet to be shown.

METHODS

A community-based, double-blind, randomized, controlled trial of ivermectin was started in Bo, Sierra Leone, in 1987. Two cohorts are reported in this study: (1) 214 subjects had received four 6-month doses of ivermectin followed by up to six additional 6-month treatments. The second cohort, with 185 subjects, had received four 6-month doses of placebo followed by up to four annual doses of ivermectin. All subjects received a full ophthalmic examination in 1989 and again in 1994. For both cohorts, there was an 18-month gap between the fifth and sixth rounds of treatment.

RESULTS

There was no significant difference in the prevalences of any ocular lesion nor of visual acuity categories between the cohorts at the second examination. Comparisons of the prevalences of anterior segment lesions for both cohorts combined between the first and second examinations show highly significant improvement (P < 0.001) for all lesions. Posterior segment lesions show a more variable pattern, with chorioretinitis showing highly significant deterioration (P < 0.001) and the emergence of new lesions in both groups.

CONCLUSION

The authors conclude that annual treatment with ivermectin is effective in controlling ocular onchocerciasis apart from chorioretinal lesions and that a 6-month treatment gives no additional benefit.

Angiotensin converting enzyme inhibition and protein restriction in progression of experimental chronic renal failure

This study examined whether the effects of protein restriction and angiotensin converting enzyme (ACE) inhibition on the progression of renal failure are common or additive. Male Sprague Dawley rats (12 wks of age) underwent 5/6 nephrectomy and were randomized to 20% protein diet (PD) (n = 9), 20% PD+enalapril (5 mg/kg/day) (n = 10), 20% PD+felodipine (30 mg/kg/day) (n = 9), 6% PD (n = 9), 6% PD+enalapril (n = 9) or 6% PD+felodipine (n = 10). Protein restriction, enalapril or felodipine treatment all retarded progression of renal failure and development of glomerular lesions. Protein restriction and enalapril appeared to have additive effects in preventing glomerular sclerosis.

Dehydroepiandrosterone does not prevent adrenocorticotrophin-induced hypertension in conscious rats

1. We tested the hypothesis that dehydroepiandrosterone (DHEA), which prevents dexamethasone-induced hypertension in rats, may block adrenocorticotrophin (ACTH) hypertension, which has been presumed due to corticosterone excess. The blood pressure and metabolic effects of DHEA (18 mg/kg per day) were examined in sham and ACTH-treated (0.5 mg/kg per day) conscious Sprague-Dawley rates (n = 20). 2. ACTH but not sham injection increased blood pressure, water intake and urine output and decreased bodyweight. 3. DHEA administration for 10 days did not alter blood pressure or metabolic effects in either sham or ACTH-treated rats. 4. DHEA, which is known to block dexamethasone-induced hypertension, did not modify ACTH-induced hypertension in the rat. This suggests either that ACTH-induced hypertension is not simply a consequence of glucocorticoid activity or that the action of DHEA in dexamethasone hypertension is not through blocking the glucocorticoid receptor.

Validation of transonic small animal flowmeter for measurement of cardiac output and regional blood flow in the rat

The objective of the present study was to validate a transonic flowmeter system with two probes (model 3SS for cardiac output (CO) and 1RB for organ flows) in Sprague-Dawley (SD) rats first by measuring blood flow through pump-infused isolated renal artery and ascending aorta, and then through measurements of CO and renal, mesenteric, and hindquarter blood flow (RBF, MBF, HBF) in vivo. We measured in vivo baseline flow and changes in flow induced by dopamine and propranolol for CO, prostaglandin E2 (PGE2), and angiotensin II (AII) for RBF and pentobarbital sodium for MBF and HBF. Correlations between meter and pump flow were linear (r = 0.999, p < 0.001) with close agreement both in ascending aorta and renal artery flow measurements. The baseline values were 15 +/- 0.7 ml/100 g/min for CO, 4 +/- 0.1 ml/100 g/min for RBF, 7 +/- 0.3 ml/100 g/min for MBF, and 6 +/- 0.3 ml/100 g/min for HBF, respectively. The system reliably detected increase and/or decrease in CO and regional blood flows. The transonic flowmeter system is accurate, highly reproducible, and compatible with other established techniques for measuring CO and regional blood flows in the rat.

Angiotensin-converting enzyme inhibition in nondiabetic progressive renal insufficiency: a controlled double-blind trial

Angiotensin-converting enzyme inhibitors delay progression of renal disease in different animal models of nephropathy. We tested this treatment modality in 70 hypertensive patients with severe renal disease of various etiologies. We report a double-blind study of the effect of 5 mg enalapril once daily compared with placebo in patients with nondiabetic severe chronic renal impairment (plasma creatinine 2.8 to 6.8 mg/dL; mean creatinine clearance 15 mL/min/1.73 m2) followed for up to 2 years. Efficacy parameters were the slopes of 51Cr-EDTA clearance, reciprocal of plasma creatinine, creatinine clearance, and the effect on urinary protein excretion. Thirty-one patients completed 2 years of treatment (12 in the enalapril group and 19 in the placebo group). Two patients died from nonrenal causes (one patient each in the enalapril and placebo groups), 16 patients commenced dialysis (seven in the enalapril group and nine in the placebo group), and eight patients were discontinued due to adverse events (five in the enalapril group and three in the placebo group). Eleven patients were discontinued because they were noncompliant, uncooperative, or moved (nine in the enalapril group and two in the placebo group). Two enalapril-treated patients were dropped from the study due to protocol deviations. Importantly, the statistical approach in this study evaluated all patients, regardless of the duration of treatment. A mixed-effects linear model and intention to treat analysis, taking into account the number of observations per patient, indicated that enalapril significantly reduced the rate of deterioration of renal disease: glomerular filtration rate (P = 0.038), reciprocal of plasma creatinine (P = 0.017), or creatinine clearance (P = 0.031). The renal protective effects of enalapril were shown to be in addition to its antihypertensive effect when blood pressure was held constant. Proteinuria was reduced by enalapril (P = 0.007) and was slightly increased in the placebo-treated patients (P = 0.051). The difference between these two groups was highly significant (P = 0.002). In conclusion, enalapril retarded the progression of chronic renal failure, as assessed by changes in glomerular filtration rate, creatinine clearance, and 1/plasma creatinine, and reduced proteinuria in patients with nondiabetic severe chronic renal insufficiency.

Preeclampsia: the effects of serum on endothelial cell prostacyclin, endothelin, and cell membrane integrity

OBJECTIVE

Our purpose was to determine whether serum from women with preeclampsia or gestational hypertension (1) decreased endothelial cell prostacyclin, (2) increased endothelial cell endothelin, and (3) caused endothelial cell damage.

STUDY DESIGN

Production of 6-keto-prostaglandin F1 alpha and endothelin by cultured endothelial cells was measured after 48 hours' incubation with sera from 23 nonpregnant women, 23 normal pregnant women, 12 women with preeclampsia, and 11 women with gestational hypertension. Structure damage of endothelial cells was assessed by a chromium release assay.

RESULTS

Serum from normal pregnant women induced more endothelial prostacyclin but less endothelin than did serum form nonpregnant women (p<0.05). No difference was found between normal pregnant and hypertensive pregnant women for prostacyclin production, but serum of preeclamptic women induced less endothelin production than did that of normal pregnant women (p<0.05). Chromium 51 release by endothelial cells was similar between normal pregnant and hypertensive pregnant groups.

CONCLUSIONS

Serum from preeclamptic women stimulates less endothelin production than does serum from normal pregnant women but does not alter prostacyclin production and is not cytotoxic to endothelial cells after short-term incubation.

L-arginine prevents corticotropin-induced increases in blood pressure in the rat

In this study we examined whether L-arginine treatment could prevent corticotropin (ACTH)-induced increases in blood pressure in the Sprague-Dawley rat. Sixty rats were randomly divided into six groups (n = 10): sham injection, ACTH injection (0.5 mg/kg per day in divided doses), L-arginine (0.6%) in food plus sham injection, L-arginine plus ACTH treatment, D-arginine (0.6%) in food plus sham injection, and D-arginine plus ACTH. Systolic pressure, water intake, urine volume, body weight, plasma and urinary electrolytes, and serum corticosterone concentrations were measured. ACTH increased systolic pressure (from 127 +/- 2 to 165 +/- 6 mm Hg, P < .001), water intake, and urine volume and decreased body weight body weight. L-Arginine reduced ACTH-induced blood pressure rises (130 +/- 3 mm Hg, P < .001) but had no effect on blood pressure in sham-treated rats. D-Arginine did not affect blood pressure in sham-treated rats, and systolic pressure in D-arginine+ACTH-treated rats was similar to that of ACTH-treated rats. L-Arginine decreased serum corticosterone concentrations in sham-treated rats (424 +/- 42 versus 238 +/- 25 ng/mL, P < .01), but D-arginine had no effect. However, both drugs decreased serum corticosterone concentrations in ACTH-treated rats (1071 +/- 117 versus 739 +/- 95 and 695 +/- 72 ng/mL for L- and D-arginine, respectively; both P < .05). As L-arginine but not D-arginine prevented ACTH-induced increases in blood pressure in Sprague-Dawley rats and both L- and D-arginine reduced serum corticosterone concentrations in ACTH-treated rats, the effects of L-arginine in preventing ACTH-induced hypertension were not simply a consequence of decreased corticosterone secretion.

A community trial of ivermectin for onchocerciasis in Sierra Leone: compliance and parasitological profiles after three and a half years of intervention

We have studied the compliance patterns and the long-term effects of repeated ivermectin at various dosing intervals in a randomized controlled trial. The setting for the trial was six neighbouring communities hyperendemic for onchocerciasis in southern Sierra Leone. A total of 335 subjects attended a survey 18 months after the fifth treatment round. Of those randomized to ivermectin, over 85% had received at least three doses. There was no evidence that women of childbearing age were consistently under-treated, despite the criteria for exclusion from treatment. An intention-to-treat analysis showed that a 6-monthly ivermectin treatment regime satisfactorily suppressed microfilarial loads. Microfilarial repopulation was significantly slower over an 18-month period after multiple doses compared to a single dose. Further analysis of microfilarial repopulation suggests that there is a cumulative suppressive effect after at least the first three doses of ivermectin, and that an annual treatment interval is as effective for short-term microfilarial suppression as a 6-monthly interval.

Long-term ouabain administration does not alter blood pressure in conscious Sprague-Dawley rats

1. We tested the ability of ouabain to cause chronic hypertension by continuously infusing ouabain for 28 days (miniosmotic pump implantation; i.p.). The blood pressure and metabolic effects of sham (150 mmol/L NaCl; n = 12) or ouabain infusion (10 micrograms/kg per day; n = 14; 100 micrograms/kg per day; n = 14) were examined in conscious Sprague-Dawley rats. 2. Plasma ouabain concentrations measured after 28 days of ouabain infusion were as follows: sham, not detectable (n = 11); ouabain 10 micrograms/kg per day, 0.60 +/- 0.07 nmol/L (n = 14); and ouabain 100 micrograms/kg per day, 7.17 +/- 0.57 nmol/L (n = 14; P < 0.001). 3. Sham or ouabain infusion did not alter food intake, bodyweight, water intake or urine output in conscious rats. 4. Blood pressure was not altered by sham treatment. Ouabain at 10 micrograms/kg per day or 100 micrograms/kg per day did not produce consistent rises in blood pressure. Ouabain at 10 micrograms/kg per day increased blood pressure on treatment day 12 only (+6 mmHg; P < 0.05), while at 100 micrograms/kg per day blood pressure increased on treatment days 16 (+9 mmHg; P < 0.05) and day 18 (+8 mmHg; P < 0.05) only. There was no significant difference in blood pressure between sham and ouabain groups. 5. Renal blood flow was decreased in rats infused with ouabain at 10 micrograms/kg per day (2.0 +/- 0.3 mL/min per 100 g bodyweight; n = 5; P < 0.01) and 100 micrograms/kg per day (2.2 +/- 0.4 mL/min per 100 g bodyweight; n = 7; P < 0.05) compared with sham treatment (3.5 +/- 0.2 mL/min per 100 g bodyweight; n = 6). Renal vascular resistance was increased in rats treated with ouabain at 10 micrograms/kg per day (65.5 +/- 12.6 mmHg/mL per min per 100 g bodyweight; n = 5; P < 0.01) and 100 micrograms/kg per day (66.0 +/- 15.6 mmHg/mL per min per 100 g bodyweight; n = 7; P < 0.05) compared with sham treatment (32.6 +/- 2.5 mmHg/mL per min per 100 g bodyweight; n = 6). 6. High plasma concentrations of ouabain do not cause consistent increases in blood pressure in conscious Sprague-Dawley rats.