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(Hypertension. 1999;34:1106-1111.)
© 1999 American Heart Association, Inc.

Scientific Contributions

Impaired Renal Adaptation to Stress in the Elderly With Isolated Systolic Hypertension

Sergio Castellani; Andrea Ungar; Claudia Cantini; Giuseppe La Cava; Claudia Di Serio; Barbara Vallotti; Anna Altobelli; Giulio Masotti

From the Istituto di Clinica Medica Generale e Cardiologia (S.C.) and Dipartimento di Fisiopatologia Clinica, Unità di Medicina Nucleare (G. La C.), Università di Firenze, and Istituto di Gerontologia e Geriatria, Università di Firenze e Azienda Ospedaliera Careggi, Firenze (A.U., C.C., C. Di S., B.V., A.A., G.M.), Italy.

Correspondence to Sergio Castellani, MD, Istituto di Clinica Medica Generale e Cardiologia, Viale Morgagni 85, Firenze 50134, Italy. E-mail castellani s{at}cesit1.unifi.its@cesit1.unifi.it

Abstract—The aim of this study was to evaluate the renal response in the elderly with isolated systolic hypertension (ISH) when an adrenergic activation, as induced by mental stress, is applied. Renal hemodynamics and kidney neurohumoral response to mental stress were studied in 8 elderly patients with ISH (aged 63 to 82 years) along with 8 elderly normotensive subjects. The study encompassed four 30-minute experimental periods (baseline, mental stress, and recovery I and II). In these patients, the mental stress–induced blood pressure rise was associated with a significant increase in both effective renal plasma flow (¹³¹I-labeled hippurate clearance) and glomerular filtration rate (¹²⁵I-labeled iothalamate clearance) (+42% and +29%, respectively; P<0.01 for both), without variations in filtration fraction, while elderly normotensives reacted to adrenergic stimulation with renal vasoconstriction but with the glomerular filtration rate constant. Variations in renal vasoactive substances, which paralleled hemodynamics of the kidney, differed in the 2 groups. In normotensives, excretion (radioimmunoassay) of endothelin-1, prostaglandin E₂, and cGMP increased during the stimulus (+50%, +54%, and +59%, respectively; P<0.05). In ISH patients the release of these autacoids did not vary in any of the experimental periods. In conclusion, in patients with ISH the renal adaptive capacity to sympathetic activation is impaired, and the data may suggest that the glomerulus passively suffers the blood pressure increase, probably because of the insufficiency of the neurohumoral response, particularly in regard to the increase of endothelin-1. This hemodynamic pattern may predispose ISH patients to a higher risk of renal injury.

Key Words: elderly • hypertension, isolated systolic • renal circulation • endothelin • prostaglandins

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