Haemodynamic, Hormonal, and Elecrolyte Responses to Withdrawal of Long-Term Captopril Treatment for Heart Failure

Maslowski, A H; Ikram, Hamid; Nicholls, M. Gary; Espiner, E. A.; Turner, J. G.

doi:10.1016/s0140-6736(81)91157-0

Cited by 28 publications

(7 citation statements)

References 9 publications

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“…For example, it has been shown that brief restoration of the integrity of the renin-angiotensin system is not accompanied by a deterioration of hemodynamic effects in patients with heart failure. 31 Converting enzyme inhibitors may increase circulating levels of bradykinin, by inhibition of the enzyme kinase II, which would result in venodilatation. 10 -32 -33 It is also possible that captopril prevents sodium and water retention that is characteristic of advanced heart failure.…”

Section: Discussionmentioning

confidence: 99%

Importance of venodilatation in prevention of left ventricular dilatation after chronic large myocardial infarction in rats: a comparison of captopril and hydralazine.

Raya

Aguirre

Goldman

1989

Circulation Research

136

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In rats with large myocardial infarctions, we compared the effects of captopril, a presumed arterial and venous vasodilator, with hydralazine, which is thought primarily to be an arterial vasodilator. To determine if the effects of captopril were dependent on the pathophysiological consequences of heart failure, we also studied a group of noninfarcted rats treated with captopril. In noninfarcted rats treated with captopril, left ventricular (LV) systolic and mean aortic pressures decreased from 132 +/- 12 to 107 +/- 15 mm Hg and 122 +/- 1 to 100 +/- 2, respectively (p less than 0.01). In noninfarcted rats, captopril decreased LV weight, LV weight/body weight, and total heart weight/body weight but produced no effects on the peripheral venous circulation. Rats subjected to coronary artery ligation were selected by ECG criteria to have large myocardial infarctions and were treated for 4 weeks with captopril (n = 8), hydralazine (n = 5), or placebo (n = 9). In infarcted rats treated with captopril, LV systolic, mean aortic pressures and LV end-diastolic pressure (LVEDP) decreased (p less than 0.01) from 115 +/- 4 to 86 +/- 3 mm Hg, 106 +/- 4 to 74 +/- 3 mm Hg, and 23 +/- 2 to 11 +/- 2 mm Hg, respectively. Mean circulatory filling pressure decreased (p less than 0.05) from 11.2 +/- 0.6 to 8.7 +/- 0.8 mm Hg and venous compliance increased (p less than 0.05) from 2.04 +/- 0.07 to 2.70 +/- 0.20 ml/mm Hg/kg. Blood volume decreased (p less than 0.05) from 67.3 +/- 0.9 to 58.2 +/- 1.8 ml/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 99%

Importance of venodilatation in prevention of left ventricular dilatation after chronic large myocardial infarction in rats: a comparison of captopril and hydralazine.

Raya

Aguirre

Goldman

1989

Circulation Research

136

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“…No changes in plasma catecholamines have been detected during acute therapy with captopril (Morganti et al, 1980). No major withdrawal phenomena have been observed after abrupt cessation of captopril therapy (Maslowski et al, 1981). In a personal series of eight hypertensive patients receiving captopril, no untoward problems were associated with their anaesthetic management (Prys-Roberts, unpublished observations).…”

Section: Angiotensin-converting Enzyme Inhibitor*mentioning

confidence: 96%

“…In this renin-dependent phase of renovascular hypertension, both plasma renin and angiotensin II concentrations are high, and the use of specific angiotensin antagonists (Saralasin) or angiotension-converting enzyme inhibitors (captopril) restores pressures to normal (Ayers et al, 1974), or prevents the development of hypertension (Miller et al, 1975). Patients with hypertension of renovascular origin present special problems during anaesthesia (Prys-Roberts, 1982a).…”

Section: Adrenergic and Other Pathophysiological Mechanisms In Hypertmentioning

confidence: 99%

Anaesthesia and Hypertension

Prys-Rroberts

1984

British Journal of Anaesthesia

113

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“…While this increased potassium is almost certainly the result of a fall in mean plasma aldosterone, the rise of potassium will limit the fall in aldosterone secretion resulting from reduced formation of angiotensin I1 (Atlas et al, 1979) and thus will alter the relationship between angiotensin I1 and aldosterone. Moreover, Maslowski et al (1981) have noted a rise in both plasma and urinary cortisol on withdrawing captopril treatment and have raised the question of an inhibitory effect of captopril on corticotrophin secretion. These various observations warn against overreliance on aldosterone measurements as a guide to angiotensin 11 suppression during captopril treatment.…”

Section: Discussionmentioning

confidence: 99%

Captopril treatment: inter‐dose variations in renin, angiotensins I and II, aldosterone and blood pressure.

Atkinson¹,

Cumming²,

Brown³

et al. 1982

Brit J Clinical Pharma

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1The ability of captopril, 150 mg three times daily by mouth, to effect sustained reduction in plasma angiotensin II, with converse increases in circulating angiotensin I, and in active, inactive and total renin concentrations, has been assessed. 2 During prolonged treatment with captopril alone, and 12 h after the last dose of the drug, plasma angiotensin II remained approximately one-sixth of basal concentrations, while angiotensin I and renin concentrations were proportionately increased. However, further increases in angiotensin I, and in active, inactive and total renin concentrations, were seen 2 and 6 h after the morning dose of 150 mg captopril. 3 Inter-dose variations in plasma aldosterone and blood pressure were not closely related to concurrent variations in the renin-angiotensin system. 4 Arguments are presented for relying on measurements of plasma renin and angiotensin concentrations rather than of renin activity or aldosterone in assessing the effectiveness of converting enzyme inhibition.

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Haemodynamic, Hormonal, and Elecrolyte Responses to Withdrawal of Long-Term Captopril Treatment for Heart Failure

Cited by 28 publications

References 9 publications

Importance of venodilatation in prevention of left ventricular dilatation after chronic large myocardial infarction in rats: a comparison of captopril and hydralazine.

Importance of venodilatation in prevention of left ventricular dilatation after chronic large myocardial infarction in rats: a comparison of captopril and hydralazine.

Anaesthesia and Hypertension

Captopril treatment: inter‐dose variations in renin, angiotensins I and II, aldosterone and blood pressure.

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