Acute and chronic effects of lisinopril on renal and systemic hemodynamics in hypertension

Degaute, Jean-Paul; Leeman, Marc; Reuse, Charles; Carlier, Elodie; Schoutens, André; Vandepapelière, Pierre

doi:10.1007/bf00055606

Cited by 4 publications

(2 citation statements)

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“…Though clearly sufficient to permit reasonably firm conclusions about common renal mechanisms of action of antihypertensive drugs, studies in humans of the renal hemodynamic effects over extended periods would benefit from being more rigorous and numerous. Many have been motivated by an attempt to display “favorable” renal effects, by which is usually meant no reduction in GFR or RBF (Textor et al, 1982 ; Bauer, 1984 ; Sugino et al, 1984 ; Dupont et al, 1987 ; Smith et al, 1987 ; Reams et al, 1988 ; Degaute et al, 1992 ; De Rosa et al, 2002 ), when it is clear that neither of these is a prerequisite for clinical efficacy. Furthermore, some studies misleadingly identify a fall in RVR as contributing to an antihypertensive effect only in proportion to the contribution this fall makes to the decrease in overall SVR (Koshy et al, 1977 ; Preston et al, 1979 ; Warren et al, 1981 ; Thananopavarn et al, 1982 ; Bauer, 1984 ; Dupont et al, 1987 ; Smith et al, 1987 ; van den Meiracker et al, 1989 ; Fridman et al, 2000 ).…”

Section: Discussionmentioning

confidence: 99%

How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure

2016

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Though antihypertensive drugs have been in use for many decades, the mechanisms by which they act chronically to reduce blood pressure remain unclear. Over long periods, mean arterial blood pressure must match the perfusion pressure necessary for the kidney to achieve its role in eliminating the daily intake of salt and water. It follows that the kidney is the most likely target for the action of most effective antihypertensive agents used chronically in clinical practice today. Here we review the long-term renal actions of antihypertensive agents in human studies and find three different mechanisms of action for the drugs investigated. (i) Selective vasodilatation of the renal afferent arteriole (prazosin, indoramin, clonidine, moxonidine, α-methyldopa, some Ca++-channel blockers, angiotensin-receptor blockers, atenolol, metoprolol, bisoprolol, labetolol, hydrochlorothiazide, and furosemide). (ii) Inhibition of tubular solute reabsorption (propranolol, nadolol, oxprenolol, and indapamide). (iii) A combination of these first two mechanisms (amlodipine, nifedipine and ACE-inhibitors). These findings provide insights into the actions of antihypertensive drugs, and challenge misconceptions about the mechanisms underlying the therapeutic efficacy of many of the agents.

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Section: Discussionmentioning

confidence: 99%

How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure

2016

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“…ACE-I are the primary antihypertensive drugs with the most nephroprotective properties. Degaute et al [ 20 ] showed a significant decrease in RVR in patients chronically treated with lisinopril. Moreover, based on the example of 20 patients treated for eight weeks with enalapril, De Cesaris et al [ 21 ] found a significant increase in effective renal plasma flow and a decrease in RVR.…”

Section: Discussionmentioning

confidence: 99%

Dynamic tissue perfusion assessment reflects associations between antihypertensive treatment and renal cortical perfusion in patients with chronic kidney disease and hypertension

et al. 2018

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PurposeRenal cortical perfusion measured in noninvasive, dynamic ultrasonic method is connected with the hemodynamic cardiac properties and renal function. Antihypertensive drugs affect the functioning of the heart and kidneys. The aim of the study was to evaluate the effect of a chronic use of antihypertensive drugs on ultrasound parameters of renal cortical perfusion.MethodsThe study included 56 consecutive patients (49 M + 7 F, age 54.0 ± 13.3) with stable chronic kidney disease and hypertension. Color Doppler dynamic tissue perfusion measurement was used to assess renal cortical perfusion.ResultsPatients were treated with a mean of 2.7 ± 1.4 antihypertensive drugs, of which diuretics accounted for 25%, angiotensin-converting enzyme inhibitors (ACE-I) together with angiotensin receptor blockers (ARB) 24%, beta-blockers (BB) 23%, calcium channel blockers 16%, alpha-1 blockers (α1B) 9% and centrally acting drugs 3%. All investigated groups of drugs correlated significantly with parameters of renal perfusion. In multivariable regression analyses adjusted to age, diuretics were connected with the decrease (r = − 0.473) and ACE-I + ARB (r = 0.390) with the improvement of proximal and whole renal cortex perfusion (R2 = 0.28; p < 0.001), whereas BB (r = − 0.372) and α1B (r = − 0.280) independently correlated with worsened perfusion of renal distal cortex (R2 = 0.21, p < 0.01).ConclusionsThe type of antihypertensive therapy had a significant influence on the ultrasound parameters of renal cortical perfusion. Noninvasive, ultrasonic dynamic tissue perfusion measurement method appears to be an adequate tool to assess the impact of drugs on renal cortical perfusion.

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ACE Inhibitors

Israili

Hall²

1995

Drugs & Aging

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High blood pressure (BP) in the elderly must not be ignored as a normal consequence of aging. The criteria for the diagnosis of hypertension and the necessity to treat it are the same in elderly and younger patients. The aim of treatment of elderly hypertensive patients is to decrease BP safely and to reduce risk factors associated with cerebrovascular, cardiovascular and renal morbidity and mortality. The treatment of elderly hypertensive patients should be adjusted according to the needs of the individual, based upon age, race, severity of hypertension, co-existing medical problems, other cardiovascular risk factors, target-organ damage, risk-benefit considerations and costs. In addition to the elevated BP, other cardiovascular risk factors include smoking, glucose intolerance, hyperinsulinaemia, dyslipidaemia, hypercreatininaemia, peripheral vascular disease, left ventricular hypertrophy, and microalbuminuria (or albuminuria). Thus, the choice of initial antihypertensive therapy in elderly hypertensive patients should be based not only on the expected response, but also on the effects of therapy on lipid, potassium, glucose and uric acid levels, and left ventricular anatomy and function. Co-existing medical conditions (such as asthma, diabetes mellitus, heart failure, renal failure, gout, coronary artery disease, hyperlipidaemia and peripheral vascular disease) are major determinants for the selection of antihypertensive medications. With previous therapies (diuretics, beta-blockers, etc.), good BP control in the elderly was associated with clear and statistically significant reductions in stroke-related morbidity and mortality, but the overall effects on cardiovascular and renal complications of hypertension was either more variable or less obvious. Angiotensin converting enzyme (ACE) inhibitors are not only efficacious antihypertensive agents in the elderly, but also appear promising in counteracting some of the cardiovascular and renal consequences of hypertension. They are well tolerated and have a relatively low incidence of adverse effects. ACE inhibitors possess ancillary characteristics that are potentially beneficial for many elderly patients, including reduction of left ventricular mass, lack of metabolic and lipid disturbances, no adverse CNS effects, no risk of induction of heart failure, and a low risk of orthostatic hypotension. Since ACE inhibitors may improve perfusion to the heart, kidney and brain, they are well worth considering for the treatment of elderly patients with hypertensive target organ damage, especially in patients with heart failure, and diabetic patients with early nephropathy.

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Acute and chronic effects of lisinopril on renal and systemic hemodynamics in hypertension

Cited by 4 publications

References 19 publications

How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure

How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure

Dynamic tissue perfusion assessment reflects associations between antihypertensive treatment and renal cortical perfusion in patients with chronic kidney disease and hypertension

ACE Inhibitors

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