EFFECT OF THERAPY WITH AN ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR ON HEMODYNAMIC AND COUNTERREGULATORY RESPONSES DURING CONTINUOUS THERAPY WITH NITROGLYCERIN

被引:49
作者
PARKER, JD
PARKER, JO
机构
[1] BRIGHAM & WOMENS HOSP,DEPT MED,DIV CARDIOVASC,BOSTON,MA 02115
[2] QUEENS UNIV,KINGSTON GEN HOSP,DEPT MED,DIV CARDIOL,KINGSTON K7L 3N6,ONTARIO,CANADA
关键词
D O I
10.1016/0735-1097(93)90322-R
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. We sought to characterize the reflex counterregulatory responses throughout a 6-day period of continuous nitroglycerin therapy and to examine the effect of concurrent administration of a non-thiol angiotensin-converting enzyme inhibitor (benazepril) on the nature of those responses. Background. Therapy with nitroglycerin has been shown to be associated with reflex counterregulatory responses. Methods. Standing systolic blood pressure, hormonal responses, urinary sodium and hematocrit levels were monitored during 6 days of continuous transdermal nitroglycerin therapy in normal volunteers. Using a double-blind randomized parallel design, 11 subjects received placebo and 9 received benazepril. Hemodynamic responses to sublingual nitroglycerin administration were evaluated before and after sustained therapy with transdermal nitroglycerin. Results. Attenuation of the hypotensive response to transdermal nitroglycerin was rapid in the group receiving placebo and the group receiving benazepril. There were no significant hormonal responses to transdermal nitroglycerin in either group, and sodium retention was modest and transient. Hematocrit levels decreased after transdermal nitroglycerin therapy and remained depressed for the duration of nitroglycerin therapy, a finding that suggests plasma volume expansion. Blood pressure responses to sublingual nitroglycerin in both groups were similar before and after continuous transdermal nitroglycerin therapy. Conclusions. These data suggest that plasma volume expansion plays a more important role than neurohormonal responses in the loss of nitrate effects during sustained therapy. That therapy with an angiotensin-converting enzyme inhibitor did not modify the hemodynamic responses to continuous nitroglycerin therapy supports this conclusion. Further investigation will be necessary to confirm whether therapy with an angiotensin-converting enzyme inhibitor has any role in the prevention of nitrate tolerance.
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页码:1445 / 1453
页数:9
相关论文
共 32 条
  • [1] DADAK N, 1990, AM J CARDIOL, V66, P608
  • [2] NITRATE TOLERANCE - INFLUENCE OF ISOSORBIDE DINITRATE ON THE HEMODYNAMIC AND ANTI-ANGINAL EFFECTS OF NITROGLYCERIN
    DALAL, JJ
    YAO, L
    PARKER, JO
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1983, 2 (01) : 115 - 120
  • [3] TOLERANCE TO INTRAVENOUS NITROGLYCERIN IN PATIENTS WITH CONGESTIVE-HEART-FAILURE - ROLE OF INCREASED INTRAVASCULAR VOLUME, NEUROHUMORAL ACTIVATION AND LACK OF PREVENTION WITH N-ACETYLCYSTEINE
    DUPUIS, J
    LALONDE, G
    LEMIEUX, R
    ROULEAU, JL
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1990, 16 (04) : 923 - 931
  • [4] DUPUIS J, 1990, CAN J CARDIOL, V6, P281
  • [5] A COMPARATIVE-STUDY OF THE DISTRIBUTIONS OF RENIN AND ANGIOTENSINOGEN MESSENGER RIBONUCLEIC-ACIDS IN RAT AND MOUSE-TISSUES
    DZAU, VJ
    ELLISON, KE
    BRODY, T
    INGELFINGER, J
    PRATT, RE
    [J]. ENDOCRINOLOGY, 1987, 120 (06) : 2334 - 2338
  • [6] INCIDENCE OF EARLY TOLERANCE TO HEMODYNAMIC-EFFECTS OF CONTINUOUS INFUSION OF NITROGLYCERIN IN PATIENTS WITH CORONARY-ARTERY DISEASE AND HEART-FAILURE
    ELKAYAM, U
    KULICK, D
    MCINTOSH, N
    ROTH, A
    HSUEH, W
    RAHIMTOOLA, SH
    [J]. CIRCULATION, 1987, 76 (03) : 577 - 584
  • [7] FUNG HL, 1988, J PHARMACOL EXP THER, V245, P524
  • [8] COMBINED USE OF NITROGLYCERIN AND N-ACETYLCYSTEINE IN THE MANAGEMENT OF UNSTABLE ANGINA-PECTORIS
    HOROWITZ, JD
    HENRY, CA
    SYRJANEN, ML
    LOUIS, WJ
    FISH, RD
    SMITH, TW
    ANTMAN, EM
    [J]. CIRCULATION, 1988, 77 (04) : 787 - 794
  • [9] IGNARRO LJ, 1981, J PHARMACOL EXP THER, V218, P739
  • [10] IMHOF PR, 1989, METHOD FIND EXP CLIN, V11, P409