| Hemodynamic effects of the angiotensin-converting enzyme inhibitor, ramipril, in patients with mild to moderate aortic stenosis and preserved left ventricular function. | |
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MedLine Citation:
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PMID: 15222408 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitor use is presumed to be contraindicated in patients with aortic stenosis (AS). We determined the hemodynamic effects of ACE inhibitors in patients with mild to moderate aortic stenosis (AS) and preserved left ventricular function. METHODS: Thirteen elderly patients (mean [SD] age = 65 [17] years), with mild to moderate AS (aortic jet velocity 2.5-4.0 m/s), normal left ventricular and renal function, and no clinical coronary artery disease, were enrolled in a single-center, open-label trial comparing the hemodynamic effects at baseline and following titration of ramipril to a maximum dose of 7.5 mg twice daily. Patients were identified from echocardiography laboratory logs. Despite a presumed contraindication to ACE inhibitor use in AS patients, 30% (71 of 235) of patients otherwise meeting inclusion or exclusion criteria were excluded owing to current ACE inhibitor use. Patients were monitored with weekly clinic visits, biweekly laboratory tests, and monthly echocardiograms. RESULTS: There were no significant changes from baseline to week 8 in echocardiographic parameters, including mean (SD) aortic jet velocity [2.9 (0.4) vs 2.9 (0.4) m/s], calculated aortic transvalvular gradient [18 (6) vs 18 (6) mm Hg], or cardiac output [5.5 (1.2) vs 6.0 (2.1) L/min], or significant changes in blood pressure or heart rate. Early discontinuations were for asymptomatic low blood pressure (one patient) or a reversible creatinine increase of 0.3 mg/dL (one patient). CONCLUSIONS: Short-term treatment with up to 7.5 mg twice daily of ramipril was well tolerated in patients with mild to moderate AS and preserved left ventricular function. A surprisingly high proportion of patients with documented AS were already receiving ACE inhibitors. |
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Authors:
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Kevin D O'Brien; Xue-Qiao Zhao; David M Shavelle; Michael T Caulfield; Rebecca A Letterer; Samir R Kapadia; Jeffrey L Probstfield; Catherine M Otto |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of investigative medicine : the official publication of the American Federation for Clinical Research Volume: 52 ISSN: 1081-5589 ISO Abbreviation: J. Investig. Med. Publication Date: 2004 Apr |
Date Detail:
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Created Date: 2004-06-29 Completed Date: 2004-07-20 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9501229 Medline TA: J Investig Med Country: Canada |
Other Details:
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Languages: eng Pagination: 185-91 Citation Subset: IM |
Affiliation:
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Division of Cardiology, University of Washington, Seattle, WA 98195-6422, USA. cardiac@u.washington.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Angiotensin-Converting Enzyme Inhibitors / contraindications, pharmacology, therapeutic use* Aortic Valve Stenosis / complications, drug therapy*, physiopathology Female Hemodynamics / drug effects* Humans Male Middle Aged Ramipril / contraindications, pharmacology, therapeutic use* Treatment Outcome Ventricular Function, Left / physiology* |
| Grant Support | |
ID/Acronym/Agency:
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M01-RR-00037/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 87333-19-5/Ramipril |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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