Norepinephrine Secretion Rate Research Articles

Hypertension and anxiety

1. 1. Epinephrine (E) as well as norepinephrine (NE) was infused during ganglion blockade in 22 hypertensive and 13 normotensive subjects and circulatory responses including digital vascular reactivity (DVR) were recorded. The apparent NE secretion rate (ANESR) was also measured in most of the subjects. 2. 2. The hypertensive group included many patients with labile as well as with established essential hypertension. 3. 3. Formal psychological tests were administered to evaluate personality “trait” anxiety (IPAT test) as well as to assess both momentary affect and rapid shifts of overt emotions in the following categories: pleasurable affect, depression, anxiety, hostility, and combined unpleasant affect (MARS test). 4. 4. No significant correlation was found between IPAT anxiety scores and DVR to E or NE, initial or resting blood pressure, initial or resting heart rate, or between such scoring and changes in blood pressure or heart rate during E infusion, in both normotensive and hypertensive groups. Correlation was significant between anxiety scores and diastolic blood pressure decrease during E infusion, but in a different direction for normotensive as against hypertensive subjects. 5. 5. Epinephrine infusion induced a significant increase in anxiety and combined unpleasant affect of a similar magnitude in normotensive and hypertensive subjects. 6. 6. In the hypertensive group, correlation between DVR to E and anxiety as well as unpleasant affect during E infusion was significant, whereas such correlation was not significant in the normotensive group. 7. 7. Although scoring for personality “trait” anxiety was no higher in the hypertensive than in the normotensive group, DVR to E was significantly higher in the hypertensive group.

Identification of Essential Hypertension in Patients with Labile Blood Pressures

Three objective tests were utilized to identify hereditary essential hypertension, namely: digital vascular reactivity (DVR), apparent norepinephrine secretion rate (ANESR) and tritiated norepinephrine uptake (TNEU) in 18 cases of labile hypertension. In nine cases, the digital vascular reactivity test was within the normal range. In the cases in which the ANESR and TNEU tests were carried out, they were largely normal. These patients were therefore considered to have anxiety hypertension only. This diagnosis can be confirmed, however, only by prolonged follow-up. In the remaining nine cases, the digital vascular reactivity test was within the range for established essential hypertension. In the cases in which ANESR and TNEU tests were carried out, they too, with a few exceptions, were in the essential hypertensive range. These patients were therefore diagnosed as having hereditary essential hypertension. Self-determined home blood pressures tended to be normal in the anxiety hypertension and elevated in the essential hypertension group.

Testing in hypertension

1. 1. In addition to routine clinical “workup,” including history, physical examination, ECG, chest x-ray, blood count, urine analysis, colony count, and culture, erythrocyte sedimentation rate, blood urea nitrogen, fasting blood sugar, serum cholesterol, uric acid, calcium, phosphorus, and electrolytes, every hypertensive patient should also have a rapid-sequence intravenous pyelogram and a catecholamine metabolite test. 2. 2. In Cushing's syndrome, urinary and/or blood assay for 17-hydroxycorticoids and 17-ketosteroids will be needed. 3. 3. In primary hyperaldosteronism, tests for excretion and secretion of aldosterone as well as tests for serum renin are important. A trial of dexamethasone therapy is indicated to exclude “congenital” hyperaldosteronism. 4. 4. In pheochromocytoma, the catecholamine metabolite test must be confirmed by the Pisano test for metanephrines and by a test for vanillylmandelic acid. In doubtful cases, the apparent NE secretion rate test may be useful. 5. 5. In renovascular hypertension, the tests needed are the rapid-sequence intravenous pyelogram and aortogram for purposes of diagnosis. If operation is being considered, a Howard or Stamey test is in order together with renal vein renin assay. Other tests may be needed here in special situations, such as the radioactive renogram, aldosterone assays, etc. 6. 6. In all cases where operation is contemplated including cases in which renal transplantation may be of value, tests for essential hypertension should also be carried out. In our hands, the two most useful tests of this kind are the norepinephrine or angiotensin digital vascular reactivity test and the apparent norepinephrine secretion rate test. 7. 7. The latter two tests are also useful in differentiating true early essential hypertension from anxiety states producing transient hypertension.