Differential effect of low-dose thiazides on the renin angiotensin system in genetically hypertensive and normotensive rats

Fifty years since thiazide diuretics were introduced, they are established as first-line antihypertensive therapy. Because the thiazide dosing profile lessened, the blood pressure lowering mechanism may lie outside their diuretic properties. We evaluated this mechanism in spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY) by examining the effects of low-dose hydrochlorothiazide (HCTZ) administration on renin-angiotensin system components. The 7-day, 1.5 mg/kg per day HCTZ did not change systolic pressure (SBP) in WKY, but decreased SBP by 41 ± 2 mm Hg (P < .0001) in SHR, independent of increased water intake, urine output, or alterations in electrolyte excretion. HCTZ significantly increased the plasma concentrations of angiotensin I (Ang I) and angiotensin II (Ang II) in both WKY and SHR while reducing angiotensin-converting enzyme (ACE) activity and the Ang II/Ang I ratio (17.1 ± 2.9 before vs. 10.3 ± 2.9 after, P < .05) only in SHR. HCTZ increased cardiac ACE2 mRNA and activity, and neprilysin mRNA in WKY. Conversely in SHR, ACE2 activity was decreased and aside from a 75% increase in AT1 mRNA in the HCTZ-treated SHR, the other variables remained unaltered. Measures of cardiac mas receptor mRNA showed no changes in response to treatment in both strains, although it was significantly lower in untreated SHR. These data, which document for the first time the effect of low-dose thiazide on the activity of the ACE2/Ang-(1-7)/mas receptor axis, suggest that the opposing arm of the system does not substantially contribute to the antihypertensive effect of thiazides.