Haemodynamic and hormonal effects of captopril in primary pulmonary hypertension.

Abstract

SUMMARY The treatment of primary pulmonary hypertension is unsatisfactory. Since, in animals, experimental pulmonary vasoconstriction may be mediated in part by angiotensin II, we treated five primary pulmonary hypertensive patients with captopril for four days. To ensure accuracy of haemodynamic and hormone data, the patients were studied under conditions of constant body posture, regulated dietary sodium and potassium intake, and unchanged diuretic therapy. Captopril reduced mean pulmonary arterial pressure in parallel with plasma angiotensin II levels. Right ventricular ejection fraction recordings increased considerably in three of four patients. Systemic arterial pressure fell, but there was no change in right atrial pressure, cardiac output, or heart rate. The decline in plasma (and urine) aldosterone levels presumably contributed to the positive cumulative potassium balance and the rise in plasma potassium (mean 0O7 mmol/l). These encouraging results suggest that converting enzyme inhibitors warrant a formal trial with prolonged follow up in the treatment of primary pulmonary hypertension.Primary pulmonary hypertension is a chronic progressive disorder of unknown aetiology. With the exception of very rare cases who survive for long periods' or show regression,2 most die within 10 years

Effects of Bisoprolol and Losartan Treatment in the Hypertrophic and Failing Right Heart

“…7 Two smaller case series have reported decreased pulmonary vascular resistance and improved RV function with captopril treatment in patients with RHF due to PAH. 36,37 Studies with patients with RHF due to an RV supporting the systemic circulation have reported no or only minor beneficial effect of treatment with ACE inhibitors or ARBs. 38,39 These contrasting results may reflect the issue of pulmonary versus cardiac effects of RAAS-blocking treatments.…”

The role of the renin‐angiotensin and natriuretic peptide systems in the pulmonary vasculature.

“…In this regard, clinical trials have been disappointing, both in their inconsistent results and in their methodology. Studies with ACE inhibitors in PPH have produced conflicting results in terms of pulmonary haemodynamic benefit [9,[25][26][27] and consequently these agents have not found a place in the treatment of these patients. In cor pulmonale, acute dosing studies have demonstrated variable effects on pulmonary haemodynamics [28][29][30][31][32][33] whereas chronic dosing studies have been short-term and have included only small numbers of patients [34,35] ( Table 1).…”

Perspectives on novel therapeutic strategies for right heart failure in pulmonary arterial hypertension: lessons from the left heart

“…In the 1980s, four small case-series (26 patients in total) reported on the haemodynamic effects of captopril in PAH. Three of the studies were positive and found a significant increase in cardiac output [60,61] and exercise capacity [62]. One study, however, did not observe any haemodynamic changes, neither positive nor negative [63].…”