Document Detail


ACE inhibition is superior to angiotensin receptor blockade for renography in renal artery stenosis.
MedLine Citation:
PMID:  12002704     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Angiotensin converting enzyme (ACE) inhibitors as well as angiotensin II receptor antagonists are able to prevent the vasoconstrictive effect of angiotensin II on the efferent renal vessels, which is believed to play an important role in renovascular hypertension. This effect is assumed to be essential for the demonstration of renovascular hypertension by captopril renography. In this study, renographic changes induced by captopril and the AT1 receptor antagonist valsartan were compared in patients with a high probability for renovascular hypertension. Twenty-five patients with 33 stenosed renal arteries (grade of stenosis >50%) and hypertension were studied. Captopril, valsartan and baseline renography were performed within 48 h using technetium-99m mercaptoacetyltriglycine. Blood pressure was monitored, plasma renin concentration before and after intervention was determined and urinary flow was estimated from the urinary output of the hydrated patients. Alterations in renographic curves after intervention were evaluated according to the Santa Fe consensus on ACE inhibitor renography. Captopril renography was positive, indicating renovascular hypertension, in 25 of the 33 stenosed vessels, whereas valsartan renography was positive in only ten. Blood pressure during captopril and valsartan renography was not different; reduction in blood pressure was the same after valsartan and captopril. Plasma renin concentration was comparable for valsartan and captopril studies, showing suppressed values after intervention in as many as 12 of the 25 patients. Urinary flow after valsartan was higher than after captopril (P<0.05). However, this difference could not explain the markedly higher sensitivity of captopril compared with valsartan in demonstrating renal artery stenosis. In 14 of the 25 patients, blood pressure response to revascularisation was monitored, showing a much better predictive value for captopril renography. It is concluded that captopril renography is much more sensitive than valsartan renography in detecting a clinically significant renal artery stenosis. Furthermore, our data suggest that other effects, such as that on the prostaglandin-bradykinin system, are of at least similar importance to ACE inhibition for the high diagnostic sensitivity of captopril renography regarding renovascular hypertension.
Authors:
Georgios Karanikas; Alexander Becherer; Karoline Wiesner; Robert Dudczak; Kurt Kletter
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  European journal of nuclear medicine and molecular imaging     Volume:  29     ISSN:  1619-7070     ISO Abbreviation:  Eur. J. Nucl. Med. Mol. Imaging     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-05-10     Completed Date:  2002-11-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  101140988     Medline TA:  Eur J Nucl Med Mol Imaging     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  312-8     Citation Subset:  IM    
Affiliation:
Department of Nuclear Medicine, University of Vienna, Austria.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors / diagnostic use*
Captopril / diagnostic use*
Female
Humans
Hypertension, Renovascular / etiology,  radionuclide imaging*
Male
Middle Aged
Radioisotope Renography / methods
Radiopharmaceuticals / diagnostic use
Receptors, Angiotensin / antagonists & inhibitors*
Renal Artery Obstruction / complications,  radionuclide imaging*
Reproducibility of Results
Sensitivity and Specificity
Technetium Tc 99m Mertiatide / diagnostic use
Tetrazoles / diagnostic use*
Valine / analogs & derivatives*,  diagnostic use*
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Radiopharmaceuticals; 0/Receptors, Angiotensin; 0/Tetrazoles; 125224-05-7/Technetium Tc 99m Mertiatide; 137862-53-4/valsartan; 62571-86-2/Captopril; 7004-03-7/Valine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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