[Studies on the mechanism of the pressor effect of mineralocorticoids. I. Influence of 9 alpha-fluorohydrocortisone on the pressor effect of tyramine, noradrenaline, and angiotensin, on blood volume, and on plasma renin concentration (author's transl)]

[Haemodynamic studies on the blood pressure-raising effect of mineralocorticoids (author's transl)]

The effects on systemic haemodynamics of long-term administration of high mineralocorticoid doses were studied in six healthy volunteers. The subjects received the synthetic steroid fludrocortisone in a daily oral dose of 0.8 mg. Central venous and arterial pressures were recorded directly, and cardiac output was determined by dye dilution method before as well as after 1 and 6 weeks of steroid application. Within the first week of steroid administration, mean arterial pressure rose by 5.6 +/- 4.6 (+/- S.D.) mm Hg (p less than 0.025). Body weight increased by 2.5 +/- 1.1 kg (p less than 0.01), and central venous pressure by 1.3 +/- 1.4 mm Hg (p less than 0.05). An increase in cardiac index was observed in all subjects, the average increase was 0.72 +/- 0.47 1/min.m2 (p less than 0.01). Heart rate decreased. After the 6th week of steroid administration, blood pressure had risen in all subjects, the average increase in mean arterial pressure was 17.8 +/- 6.0 mm Hg (p less than 0.001). This pressure rise was the consequence of an increase in total peripheral resistance by 267 +/- 125 dyn.cm-5.s (p less than 0.01) on the average. At that time cardiac index was even lower than at the first study in five of the six subjects. Compared to the second study, heart rate had decreased further, central venous pressure had increased further, and body weight had not changed significantly. This data show that the mineralocorticoid-induced blood pressure rise is initially due to an increase in cardiac output and in its chronic phase due to an elevated peripheral resistance. The mechanism of the increase in peripheral resistance remains unclear.

[Circulatory reflexes in primary aldosteronism (author's transl)]

1. In 7 patients with hypertension, aldosteronism, and low plasma renin (6 patients with a solitary adrenal adenoma, 1 patient with bilateral adrenal hyperplasia) circulatory reflexes (Valsalva's maneuver, head-up tilt and cold pressure test) were examined. Furthermore, the reactivity to the pressor action of tyramine and norepinephrine was determined. For comparison 10 patients with essential hypertension were studied. 2. In 4 of the 7 patients with primary aldosteronism no overshoot following Valsalva's maneuver could be observed. Compared to the patients with essential hypertension the mean overshoot in the patients with primary aldosteronism was significantly reduced. The decrease in blood pressure during head-up tilt was significantly more pronounced in the patients with primary aldosteronism. However, both groups did not differ in their reaction to the cold pressure test. In the patients with primary aldosteronism responsiveness to tyramine was significantly reduced compared to the patients with essential hypertension. No significant difference was observed in the reactivity to norepinephrine between both groups studied. 3. The results point towards a disturbance of the sympathetic nervous system in patients with primary aldosteronism.