Adrenocortical hormones in human hypertension and their relation to angiotensin.

P WORK from our laboratory has shown a significant mean increase in urinary aldosterone in groups of patients with essential, renal, and malignant hypertension and its excessive daily fluctuations in benign and severe hypertensive patients." These results have been confirmed by several groups of workers*" and by R. Romanelli (personal communication). More recently, Laragh et al. have found increased aldosterone secretion rates in most patients with severe hypertension and almost all patients with malignant hypertension, but not in so-called primary benign hypertension. This report was not confirmed in preliminary studies of patients with malignant hypertension by Muller. In addition, we have demonstrated a significant mean decrease in urinary pregnanetriol in the same groups of hypertensive patients as compared to normal subjects. The urinary pregnanetriol/aldosterone ratio is below the lower limit of the normal range in 92 per cent of all hypertensive patients studied.' 3 As significant as these results appear in human hypertension, it is difficult, and indeed impossible, to overlook the role of the kidney if one considers the whole of the clinical and experimental evidence linking the kidney to the hypertensive process. The strong experimental evidence in rats linking the juxtaglomerular cells of the kidney to the adrenal zone glomerulosa and sodium is outlined in great detail in a recent and most comprehensive review by Tobian. It was therefore logical for our group to