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. 1986 Nov;56(5):433–439. doi: 10.1136/hrt.56.5.433

Hormonal, global, and regional haemodynamic responses to a vascular antagonist of vasopressin in patients with congestive heart failure with and without hyponatraemia.

P Nicod, J Biollaz, B Waeber, J J Goy, R Polikar, J Schlapfer, M D Schaller, G A Turini, J Nussberger, K G Hofbauer, et al.
PMCID: PMC1236889  PMID: 3790379

Abstract

The pathophysiological role of an increase in circulating vasopressin in sustaining global and regional vasoconstriction in patients with congestive heart failure has not been established, particularly in patients with hyponatraemia. To assess this further, 20 patients with congestive heart failure refractory to digoxin and diuretics were studied before and 60 minutes after the intravenous injection (5 micrograms/kg) of the vascular antagonist of vasopressin [1(beta-mercapto-beta,beta-cyclopentamethylene-propionic acid), 2-(0-methyl) tyrosine] arginine vasopressin. Ten patients were hyponatraemic (plasma sodium less than 135 mmol/l) and 10 were normonatraemic. In both groups of patients the vascular vasopressin antagonist did not alter systemic or pulmonary artery pressures, right atrial pressure, pulmonary capillary wedge pressure, cardiac index, or vascular resistances. Furthermore, there was no change in skin and hepatic blood flow in either group after the injection of the vascular antagonist. Only one patient in the hyponatraemic group showed considerable haemodynamic improvement. He had severe congestive heart failure and a high concentration of plasma vasopressin (51 pmol/l). Plasma renin activity, vasopressin, or catecholamine concentrations were not significantly changed in response to the administration of the vasopressin antagonist in either the hyponatraemic or the normonatraemic groups. Patients with hyponatraemia, however, had higher baseline plasma catecholamine concentrations, heart rate, pulmonary pressure and resistance, and lower hepatic blood flow than patients without hyponatraemia. Plasma vasopressin and plasma renin activity were slightly, though not significantly, higher in the hyponatraemic group. Thus the role of vasopressin in sustaining regional or global vasoconstriction seems limited in patients with congestive heart failure whether or not concomitant hyponatraemia is present. Vasopressin significantly increases the vascular tone only in rare patients with severe congestive heart failure and considerably increased vasopressin concentrations. Patients with hyponatraemia do, however, have raised baseline catecholamine concentrations, heart rate, pulmonary arterial pressure and resistance, and decreased hepatic blood flow.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Awan N. A., Miller R. R., Miller M. P., Specht K., Vera Z., Mason D. T. Clinical pharmacology and therapeutic application of prazosin in acute and chronic refractory congestive heart failure. Balanced systemic venous and arterial dilation improving pulmonary congestion and cardiac output. Am J Med. 1978 Jul;65(1):146–154. doi: 10.1016/0002-9343(78)90703-9. [DOI] [PubMed] [Google Scholar]
  2. Bonjour J. P., Malvin R. L. Stimulation of ADH release by the renin-angiotensin system. Am J Physiol. 1970 Jun;218(6):1555–1559. doi: 10.1152/ajplegacy.1970.218.6.1555. [DOI] [PubMed] [Google Scholar]
  3. Brunner D. B., Burnier M., Brunner H. R. Plasma vasopressin in rats: effect of sodium, angiotensin, and catecholamines. Am J Physiol. 1983 Feb;244(2):H259–H265. doi: 10.1152/ajpheart.1983.244.2.H259. [DOI] [PubMed] [Google Scholar]
  4. Bussien J. P., Waeber B., Nussberger J., Schaller M. D., Gavras H., Hofbauer K., Brunner H. R. Does vasopressin sustain blood pressure of normally hydrated healthy volunteers? Am J Physiol. 1984 Jan;246(1 Pt 2):H143–H147. doi: 10.1152/ajpheart.1984.246.1.H143. [DOI] [PubMed] [Google Scholar]
  5. CAESAR J., SHALDON S., CHIANDUSSI L., GUEVARA L., SHERLOCK S. The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci. 1961 Aug;21:43–57. [PubMed] [Google Scholar]
  6. CHIDSEY C. A., BRAUNWALD E., MORROW A. G. CATECHOLAMINE EXCRETION AND CARDIAC STORES OF NOREPINEPHRINE IN CONGESTIVE HEART FAILURE. Am J Med. 1965 Sep;39:442–451. doi: 10.1016/0002-9343(65)90211-1. [DOI] [PubMed] [Google Scholar]
  7. Curtiss C., Cohn J. N., Vrobel T., Franciosa J. A. Role of the renin-angiotensin system in the systemic vasoconstriction of chronic congestive heart failure. Circulation. 1978 Nov;58(5):763–770. doi: 10.1161/01.cir.58.5.763. [DOI] [PubMed] [Google Scholar]
  8. Fichman M. P., Vorherr H., Kleeman C. R., Telfer N. Diuretic-induced hyponatremia. Ann Intern Med. 1971 Dec;75(6):853–863. doi: 10.7326/0003-4819-75-6-853. [DOI] [PubMed] [Google Scholar]
  9. Goldsmith S. R., Francis G. S., Cowley A. W., Jr, Levine T. B., Cohn J. N. Increased plasma arginine vasopressin levels in patients with congestive heart failure. J Am Coll Cardiol. 1983 Jun;1(6):1385–1390. doi: 10.1016/s0735-1097(83)80040-0. [DOI] [PubMed] [Google Scholar]
  10. Grainger S. L., Keeling P. W., Brown I. M., Marigold J. H., Thompson R. P. Clearance and non-invasive determination of the hepatic extraction of indocyanine green in baboons and man. Clin Sci (Lond) 1983 Feb;64(2):207–212. doi: 10.1042/cs0640207. [DOI] [PubMed] [Google Scholar]
  11. Hollenberg N. K., Williams G. H., Burger B., Ishikawa I., Adams D. F. Blockade and stimulation of renal, adrenal, and vascular angiotensin II receptors with 1-Sar, 8-Ala angiotensin II in normal man. J Clin Invest. 1976 Jan;57(1):39–46. doi: 10.1172/JCI108266. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Johnson A. K., Mann J. F., Rascher W., Johnson J. K., Ganten D. Plasma angiotensin II concentrations and experimentally induced thirst. Am J Physiol. 1981 Mar;240(3):R229–R234. doi: 10.1152/ajpregu.1981.240.3.R229. [DOI] [PubMed] [Google Scholar]
  13. Johnston G. D., Kelly J. G., McDevitt D. G. Do patients take digoxin? Br Heart J. 1978 Jan;40(1):1–7. doi: 10.1136/hrt.40.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kramer R. S., Mason D. T., Braunwald E. Augmented sympathetic neurotransmitter activity in the peripheral vascular bed of patients with congestive heart failure and cardiac norepinephrine depletion. Circulation. 1968 Oct;38(4):629–634. doi: 10.1161/01.cir.38.4.629. [DOI] [PubMed] [Google Scholar]
  15. Kruszynski M., Lammek B., Manning M., Seto J., Haldar J., Sawyer W. H. [1-beta-Mercapto-beta,beta-cyclopentamethylenepropionic acid),2-(O-methyl)tyrosine ]argine-vasopressin and [1-beta-mercapto-beta,beta-cyclopentamethylenepropionic acid)]argine-vasopressine, two highly potent antagonists of the vasopressor response to arginine-vasopressin. J Med Chem. 1980 Apr;23(4):364–368. doi: 10.1021/jm00178a003. [DOI] [PubMed] [Google Scholar]
  16. Levine T. B., Franciosa J. A., Vrobel T., Cohn J. N. Hyponatraemia as a marker for high renin heart failure. Br Heart J. 1982 Feb;47(2):161–166. doi: 10.1136/hrt.47.2.161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Levine T. B., Francis G. S., Goldsmith S. R., Simon A. B., Cohn J. N. Activity of the sympathetic nervous system and renin-angiotensin system assessed by plasma hormone levels and their relation to hemodynamic abnormalities in congestive heart failure. Am J Cardiol. 1982 May;49(7):1659–1666. doi: 10.1016/0002-9149(82)90243-0. [DOI] [PubMed] [Google Scholar]
  18. Lilly L. S., Dzau V. J., Williams G. H., Rydstedt L., Hollenberg N. K. Hyponatremia in congestive heart failure: implications for neurohumoral activation and responses to orthostasis. J Clin Endocrinol Metab. 1984 Nov;59(5):924–930. doi: 10.1210/jcem-59-5-924. [DOI] [PubMed] [Google Scholar]
  19. Nicod P., Waeber B., Bussien J. P., Goy J. J., Turini G., Nussberger J., Hofbauer K. G., Brunner H. R. Acute hemodynamic effect of a vascular antagonist of vasopressin in patients with congestive heart failure. Am J Cardiol. 1985 Apr 1;55(8):1043–1047. doi: 10.1016/0002-9149(85)90743-x. [DOI] [PubMed] [Google Scholar]
  20. Nilsson G. E., Tenland T., Oberg P. A. Evaluation of a laser Doppler flowmeter for measurement of tissue blood flow. IEEE Trans Biomed Eng. 1980 Oct;27(10):597–604. doi: 10.1109/TBME.1980.326582. [DOI] [PubMed] [Google Scholar]
  21. Peuler J. D., Johnson G. A. Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine and dopamine. Life Sci. 1977 Sep 1;21(5):625–636. doi: 10.1016/0024-3205(77)90070-4. [DOI] [PubMed] [Google Scholar]
  22. Schaer G. L., Covit A. B., Laragh J. H., Cody R. J. Association of hyponatremia with increased renin activity in chronic congestive heart failure: impact of diuretic therapy. Am J Cardiol. 1983 Jun;51(10):1635–1638. doi: 10.1016/0002-9149(83)90200-x. [DOI] [PubMed] [Google Scholar]
  23. Schrier R. W., Berl T. Nonosmolar factors affecting renal water excretion (second of two parts). N Engl J Med. 1975 Jan 16;292(3):141–145. doi: 10.1056/NEJM197501162920306. [DOI] [PubMed] [Google Scholar]
  24. Szatalowicz V. L., Arnold P. E., Chaimovitz C., Bichet D., Berl T., Schrier R. W. Radioimmunoassay of plasma arginine vasopressin in hyponatremic patients with congestive heart failure. N Engl J Med. 1981 Jul 30;305(5):263–266. doi: 10.1056/NEJM198107303050506. [DOI] [PubMed] [Google Scholar]

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