Role of renal hemodynamics in the exaggerated natriuresis of essential hypertension

Abstract

Extracellular fluid volume expansion is known to produce exaggerated natriuresis in essential hypertension. In order to assess the role of hemodynamic and intrarenal physical factors upon natriuretic response to central volume expansion, two hour water immersion (WI) experiments were made in six uncomplicated essential hypertensives and six normotensive healthy controls. Before and during WI we measured mean arterial pressure (MAP), urine flow (V/min), sodium (U(Na)V) and potassium (U(K)V) excretion, glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and intrarenal (wedged) venous pressure (IRVP). In comparison with normotensive controls, the exaggerated natriuretic response in hypertensives (P < 0.05 for U(Na)V during WI) was associated with an enhanced vasodilating response as demonstrated by a greater increase in ERPF (P < 0.05) and by a more pronounced fall in calculated renal precapillary resistances (P < 0.05). A more significant increase in IRVP was found in hypertensive group (P < 0.05). Glomerular filtration rate (GFR) did not change in either group during WI. MAP, unchanged in normotensives, was significantly reduced in hypertensives (P < 0.05), while remaining in the hypertensive range. These findings suggest that intrarenal physical factors play a major role in determining the exaggerated natriuresis during WI in hypertensive man.