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Hämodynamische Untersuchungen zur blutdrucksteigernden Wirkung von Mineralocorticoiden

Haemodynamic studies on the blood pressure-raising effect of mineralocorticoids

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Summary

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<0.025). Body weight increased by 2.5±1.1 kg (p<0.01), and central venous pressure by 1.3±1.4 mm Hg (p<0.05). An increase in cardiac index was observed in all subjects, the average increase was 0.72±0.47 l/min·m2 (p<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<0.001). This pressure rise was the consequence of an increase in total peripheral resistance by 267±125 dyn·cm−5·s (p<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.

The 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.

Zusammenfassung

Bei 6 gesunden freiwilligen Probanden wurde der Einfluß einer längerfristigen hochdosierten Mineralocorticoid-Applikation auf die Hämodynamik untersucht. Die Versuchspersonen erhielten das synthetische Mineralocorticoid 9α-Fluorhydrocortison in einer Dosierung von 0,8 mg p.o. täglich. Vor der Gabe des Steroids sowie nach 1- und 6wöchiger Steroidbehandlung wurden der zentrale Venendruck und der arterielle Blutdruck direkt gemessen, das Herzzeitvolumen wurde mittels Farbstoffverdünnungsmethode bestimmt.

Innerhalb der 1. Woche der Mineralocorticoid-Einnahme stieg der arterielle Mitteldruck um durchschnittlich 5,6±4,6 mm Hg (±S.D.) (p<0,025) an. Das Körpergewicht stieg um durchschnittlich 2,5±1,1 kg (p<0,01), der zentrale Venendruck um 1,3±1,4 mm Hg (p<0,05). Bei allen Versuchspersonen kam es zu einer Zunahme des Herzzeitvolumens, die im Durchschnitt 0,72±0,47 l/min×m2 (p<0,01) betrug. Die Herzfrequenz nahm ab.

Nach der 6. Woche der Steroidgabe war der Blutdruck bei allen Probanden deutlich angestiegen, der durchschnittliche Anstieg des arteriellen Mitteldrucks betrug 17,8±6,0 mm Hg (p<0,001). Dieser Druckanstieg war die Folge einer Erhöhung des peripheren Gesamtwiderstands um durchschnittlich 267±125 dyn·cm−5·s (p<0,01). Das Herzzeitvolumen lag zu diesem Zeitpunkt bei 5 der 6 Probanden sogar niedriger als bei der ersten Untersuchung. Gegenüber der 1. Woche zeigte die Herzfrequenz eine weitere Abnahme, der zentrale Venendruck einen weiteren Anstieg, das Körpergewicht dagegen keine sichere Veränderung.

Die Untersuchungen zeigen, daß der mineralocorticoid-induzierte Blutdruckanstieg initial Folge eines erhöhten Herzzeitvolumens, in der chronischen Phase Folge einer Erhöhung des peripheren Widerstands ist. Der Mechanismus des Widerstandsanstiegs bleibt unklar.

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  1. I. Medizinische Klinik und Poliklinik der Johannes Gutenberg-Universität Mainz, Germany

    A. Distler & Th. Philipp

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  1. A. Distler
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Herrn Prof. Dr. H.P. Wolff, Mainz, zum 65. Geburtstag gewidmet

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Distler, A., Philipp, T. Hämodynamische Untersuchungen zur blutdrucksteigernden Wirkung von Mineralocorticoiden. Klin Wochenschr 57, 1177–1183 (1979). https://doi.org/10.1007/BF01491758

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