Zusammenfassung
Die Bedeutung des SAS und RAS für extreme Blutdrucksteigerungen bei akuter hypertensiver Enzephalopathie wird anhand zweier Patienten mit Glomerulonephritis diskutiert. Erhöhte Katecholamin-Plasmaspiegel und gesteigerte Vanillin-Madelsäure-Ausscheidung sowie Depressor-Reaktion auf Phentolamin während der hypertensiven Krise deuteten auf eine Aktivierung des SAS hin, wodurch ein Phäochromozytom vorgetäuscht wurde. Stark erhöhte Plasma-Renin-Aktivität und Depressor-Reaktion auf Saralasin weisen auf eine gleichzeitige Stimulierung des RAS hin. Die hypertensiven Krisen beider Patienten scheinen durch gleichzeitige und gegenseitige Stimulation der beiden Systeme agraviert.
Als antihypertensives Therapiekonzept bei hypertensiven Krisen mit exzessiver Stimulation des SAS und RAS erweist sich die Kombination von α- und β-Rezeptoren-Blockern und/oder Saralasin als wert-voll.
Summary
The role of the SAS and RAS in hypertensive crisis combined with encephalopathy is discussed in the light of two casuistics with chronic glomerulonephritis. Increased plasma levels of catecholamines, and increased urinary excretion of 4-OH-3-methoxymandelic acid, as well as depressor response to phentolamine during the hypertensive crisis suggested an enhanced activity of SAS, mimicking the features of phaeochromocytoma.
Excessive hyperreninaemia and depressor response to saralasin hinted at a stimulation of RAS. The two systems seem to stimulate one another and to cause the vicious circle of hypertensive crisis.
As antihypertensive treatment concepts in the hypertensive crisis with excessive stimulation of SAS and RAS, combination of α- and β-adrenergic receptor blockade and/or direct vascular angiotensin II antagonism by saralasin proved to be worthy.
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Dedicated to Prof. Dr. F. Gross on the occasion of his 65th birthday
Supported by the Deutsche Forschungsgemeinschaft
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Röckel, A., Reuther, P., Deeg, P. et al. Stimulation of the sympathico-adrenergic (SAS) and renin-angiotensin-system (RAS) in hypertensive crisis. Klin Wochenschr 57, 1185–1190 (1979). https://doi.org/10.1007/BF01491759
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DOI: https://doi.org/10.1007/BF01491759
Schlüsselwörter
- Hypertensive Krise
- Enzephalopathie
- Sympathikoadrenerges System
- Renin-Angiotensin-System
- Therapie (α- und β-Rezeptorenblocker — Saralasin)