Prolonged clonidine treatment: catecholamines, renin activity and aldosterone following exercise in hypertensives

Eight patients with essential hypertension, WHO grade I-III, were studied under standardized conditions in a metabolic ward, before and after 8-20 weeks of treatment with clonidine in a maintenance dose of 300-600 micrograms/24 h. Before clonidine, plasma noradrenaline concentration (PNA), plasma adrenaline concentration (PA), plasma renin activity (PRA) and plasma aldosterone concentration (PAC) increased in response to standing and submaximal exercise for 20 min. PNA was positively correlated to pulse rate in the supine position (R = 0.74, p 0.05) and the increase in PNA to the increase in pulse rate during exercise (min 10, R=0.73, p less than 0.05; min 15, R = 0.79, p less than 0.05; min 20, R = 0.74, p less than 0.05). No other significant correlations were found between PNA, PA, PRA and PAC on the one hand and blood pressure (BP) and pulse rate on the other. Clonidine reduced BP, pulse rate, PNA and PRA under all conditions studied. PA was reduced in the upright position and in connection with exercise. PAC was reduced during clonidine after exercise but otherwise unaltered. The clonidine-induced decrease in PNA was positively correlated to the decrease in diastolic BP both in the supine (R = 0.76, p less than 0.05) and in the upright (R = 0.80, p less than 0.05) position. thus, long-term clonidine treatment lowered the BP and pulse rate, at least partly by reducing sympathetic activity via a central mechanism. However, clonidine did not block the sympathetic reflex mechanisms engaged in the maintenance of BP in the upright position. During clonidine, the adrenaline values were lower than before treatment in the supine and in the upright position and also following exercise, indicating that clonidine exerts an inhibitory effect on the sympatho-adreno-medullary system.