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Article Review/Hyperlink
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Kohno M, Hanehira T, Kano H, Horio T, Yokokawa K, Ikeda M,
Minami M, Yasuanari K, Yoshikawa J
Plasma adrenomedullin concentrations in essential hypertension
Hypertension
(Jan) 27:102-196 1996

Adrenomedullin, originally isolated from tissue extracts of
pheocromocytoma, is a very potent vasorelaxant peptide which is also
synthesized by endothelial cells where it inhibits the synthesis of
endothelin-1. Kohno and coworkers measured the plasma concentration (by
RIA) of this peptide in patients with various degrees of hypertension
and renal damage and in control subjects. The study groups were well
matched and the analytical methods employed sound and reliable.
Adrenomedullin was definitely raised (above the upper limit of the
normal range) in about half of the patients with clear-cut hypertension
but normal in patients with "borderline" hypertension. Interestingly,
plasma adrenomedullin levels were independent of arterial pressure
(and unmodified by
antihypertensive treatment) and uncorrelated with the degree of left
ventricular hypertrophy, but strongly
related to the GFR. The behaviour of circulating adrenomedullin in
essential hypertension appears similar to that of endothelin-1 (see
paper by the same authors on the Am J Med 1990;88,614) which also is very
much dependent on renal function. The renal synthesis of endothelin
increases when renal function declines. Whether raised plasma adrenomedullin
is attributable to reduced renal degradation or increased synthesis is
presently unknown. This stimulating paper puts into clinical
perspective a new factor which may take part at vascular and renal
level in the complex interplay which sets prevailing vascular tone.
(Carmine Zoccali, M.D.)
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