Document Detail


Contribution of volume overload and angiotensin II to the increased pulse wave velocity of hemodialysis patients.
MedLine Citation:
PMID:  11752035     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Aortic compliance is decreased in patients with end-stage renal disease. This malfunction contributes to high aortic systolic pressures and thus to the development of left ventricular hypertrophy. It was hypothesized that besides structural vascular changes, functional changes as a result of hypervolemia and increased vasoconstrictor activity, in particular angiotensin II, play a role in decreasing aortic compliance. Nineteen hemodialysis patients were studied before and 24 h after they had been dialyzed to dry weight. Applanation tonometry of peripheral arteries was used to estimate aortic pulse wave velocity (PWV), known to depend on aortic compliance, and aortic systolic pressure augmentation (augmentation index [Aix]). Predialysis aortic PWV was increased in the dialysis patients compared with matched healthy subjects (9.9 +/- 3.1 versus 7.5 +/- 1.1 m/s; P < 0.05). The AIx was also increased (35 +/- 6 versus 25 +/- 10; P < 0.05). Volume reduction with dialysis had no significant effect on PWV (9.3 +/- 1.5 m/s), but the AIx decreased (28 +/- 7; P < 0.05). A subset of 10 patients were restudied after 1 wk of angiotensin-converting enzyme inhibition (ACEi) with enalapril 5 mg once daily. ACEi decreased both predialysis as postdialysis BP but had no effect on pulse pressure and heart rate, which remained elevated compared with healthy subjects. ACEi also decreased predialysis aortic PWV, from 11.0 +/- 3.5 to 9.1 +/- 2.1 m/s (P < 0.05) but had no significant effect on AIx. During treatment with ACEi, the same volume reduction with dialysis decreased aortic PWV further to 8.0 +/- 1.4 m/s (P < 0.05), a figure not different from PWV in healthy subjects. AIx decreased to an even slightly subnormal value (12 +/- 23; P < 0.05). It was concluded that volume overload and angiotensin II both contribute to elevated PWV and AIx in dialysis patients. Volume reduction and ACEi both improve the aortic PWV and AIx. Combined volume reduction and ACEi has an enhanced effect that, in the present patients, was so large that PWV and AIx were no longer elevated. Monitoring and correcting of arterial pressure waves is feasible and may be an important tool in the treatment of patients with end-stage renal disease.
Authors:
J L Tycho Vuurmans; Walther H Boer; Willem-Jan W Bos; Peter J Blankestijn; Hein A Koomans
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  13     ISSN:  1046-6673     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2001-12-25     Completed Date:  2002-02-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  177-83     Citation Subset:  IM    
Affiliation:
Department of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Angiotensin II / physiology*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Aorta / physiopathology
Blood Pressure / drug effects
Brachial Artery / physiopathology
Enalapril / therapeutic use
Female
Humans
Hyperemia / physiopathology*
Male
Middle Aged
Pulse*
Reference Values
Renal Dialysis*
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 11128-99-7/Angiotensin II; 75847-73-3/Enalapril

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


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