Document Detail

Renal hemodynamic effects in patients with moderate to severe heart failure during chronic treatment with trandolapril.
MedLine Citation:
PMID:  9825186     Owner:  NLM     Status:  MEDLINE    
Treatment of patients with severe heart failure by ACE inhibition is often limited by worsening of renal function. To evaluate whether trandolapril, a potent lipophilic ACE inhibitor, affects renal function in severe heart failure, we studied 12 patients with severe heart failure treated with only diuretics and digoxin. Patients received increasing oral dosages of trandolapril (0, 1, and 2 mg) on 3 consecutive days (A). Patients were then discharged on 2 mg trandolapril bid and re-evaluated 8 weeks later (B). Mean arterial and pulmonary wedge pressures decreased by maximal 14% and 43%, and stroke volume and work indexes increased by 24% and 20% at A and similarly at B (11, 45, and 25 ns and 33%, respectively). In contrast, heart rate, systemic resistance, pulmonary artery pressure, and cardiac index decreased by 6%, 23%, 29%, and 17%, respectively, at only A. Renal blood flow improved by approximately 40% both at A and B. In contrast, the glomerular filtration rate decreased by 25% at only B, whereas serum creatinine, creatinine clearance, and urine osmolality were unaffected during the study. Norepinephrine, angiotensin II, and aldosterone levels decreased by approximately 30%, 60%, and 65%, respectively, at both A and B. Renin levels increased by 136% at A and remained elevated at B. Thus, whereas the initial systemic vasodilating and inotropic effects did not persist, long-term trandolapril results in sustained neurohormonal modulation, reduced preload, and improved organ perfusion, indicated by a persistent increase in renal blood flow and preservation of renal function in severe heart failure.
M van der Ent; W J Remme; P W de Leeuw; G L Bartels
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy     Volume:  12     ISSN:  0920-3206     ISO Abbreviation:  Cardiovasc Drugs Ther     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1999-03-02     Completed Date:  1999-03-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8712220     Medline TA:  Cardiovasc Drugs Ther     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  395-403     Citation Subset:  IM    
Sticares Cardiovascular Research Foundation, Rotterdam, The Netherlands.
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MeSH Terms
Aldosterone / metabolism
Angiotensin II / metabolism
Angiotensin-Converting Enzyme Inhibitors / pharmacology*
Antihypertensive Agents / pharmacology*
Digoxin / therapeutic use
Diuretics / therapeutic use
Epinephrine / metabolism
Heart Failure / physiopathology*
Heart Rate / drug effects
Indoles / pharmacology*
Kidney / drug effects*
Middle Aged
Neurotransmitter Agents / metabolism
Norepinephrine / metabolism
Pulmonary Wedge Pressure / drug effects
Renal Circulation / drug effects*
Renin / metabolism
Time Factors
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Diuretics; 0/Indoles; 0/Neurotransmitter Agents; 11128-99-7/Angiotensin II; 20830-75-5/Digoxin; 51-41-2/Norepinephrine; 51-43-4/Epinephrine; 52-39-1/Aldosterone; 87679-37-6/trandolapril; EC

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