Hypertension Clinical Trial
To study calcium metabolism and the renin-angiotensin system in hypertensive and normal pregnancy.
BACKGROUND:
Beginning in Fiscal Year 1975, the multidisciplinary SCOR examined causes, consequences, and
treatments of human hypertension. A central theme was the renal basis for human
hypertension. The subproject on calcium metabolism and the renin-angiotensin system in
hypertensive and normal pregnancy began in December, 1990.
DESIGN NARRATIVE:
A longitudinal study was performed on normal pregnant women and women with chronic
hypertension who had a high incidence of superimposed preeclampsia. In a previous study, the
investigators had demonstrated that preeclampsia was associated with reduced urinary
excretion of calcium and with lower plasma renin activity (PRA) compared with normal
pregnancy. The goal of the investigators was to identify the metabolic and cellular basis
for these alterations in calcium homeostasis and in the renin angiotensin system. They
tested two hypotheses. The first hypothesis was that diminished placental and/or renal
production of 1,25-dihydroxyvitamin D, leading to lower serum calcium, higher parathyroid
hormone, and increased renal tubular reabsorption of calcium, was the metabolic basis for
hypocalciuria in preeclampsia. The second hypothesis was that lower PRA in preeclampsia was
due to systemic and renal vasoconstriction with hypertension and diminished natriuresis.
Serial measurements of 1,25-dihydroxyvitamin D, parathyroid hormone, serum ionized calcium,
PRA, estradiol and progesterone, and urinary calcium and electrolytes were obtained,
particularly at the onset of preeclampsia. Acute renal hemodynamic studies were also
performed in women with preeclampsia and in gestational age matched normals. The studies
investigated the relationships among glomerular filtration rate, renal blood flow,
parathyroid hormone, vitamin D, atrial natriuretic factor, renin, estradiol and
progesterone, and sodium and calcium excretion during infusion of inulin and PAH with either
saline or calcium chloride.
Intracellular free calcium concentration in platelets and lymphocytes of pregnant women
participating in longitudinal and acute renal hemodynamic studies were also measured. Basal
and stimulated (with angiotensin II, ionomycin and thrombin), intracellular free calcium
concentrations were compared in normal and hypertensive pregnant women and correlated with
calcium regulatory hormones, plasma renin activity and hypertension.
The study completion date listed in this record was obtained from the "End Date" entered in
the Protocol Registration and Results System (PRS) record.
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