Atlas of Hypertension by Norman K. Hollenberg (ed.)

By Norman K. Hollenberg (ed.)

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30 - • - 40 rE E :;... ~. ~. U .. ~. \Y: c: '" •• -10 - • - 20 - - 40 Maximum rise HG 10th minute of visit o I ... ,: ,i I 1/ : °. ". -.. },. • • •••• • •• .... • Baseline Stress ' , .... / ,: I 10th minute after visit FIGURE 2-16. Reflex changes in blood pressure induced by mental arithmetic (MA), submaximal isometric handgrip (HG), and cold pressor testing (CP) in young men with borderline hypertension [8]. The rise in blood pressure produced by mental arithmetic represents a pure, centrally mediated response.

Pharmacologic effects are further influenced by different genotypes of the drug receptor, which have different sensitivity to the medication, as depicted by the curves of drug concentration versus effects, middle. Patients with a wt/wt receptor genotype exhibit a greater effect of any given drug concentration in comparison with those with a wt/m receptor genotype, whereas those with m/m genotypes are relatively refractory to drug effects at any plasma drug concentration. These two genetic polyrnorphisms (in drug metabolism and drug receptors) yield nine different theoretical patterns of drug effects, right.

Blood pressure increases during dietary potassium restriction. In this study of normotensive men, lowering the potassium intake from a usual level (90 mEq/ d) to a very low level (10 mEq/ d) induced an increase in blood pressure and a decrease in plasma potassium concentration [72]. The mechanisms that mediate the effect of potassium restriction on blood pressure are not known but may include sodium retention, hormonal changes, and inhibition of membrane Na+-K+ ATPase. (Adapted from Krishna et al.

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