Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1978 Oct;40(10):1134–1142. doi: 10.1136/hrt.40.10.1134

Congestive heart failure in normotensive man. Haemodynamics, renin, and angiotensin II blockade.

G A Turini, H R Brunner, R K Ferguson, J L Rivier, H Gavras
PMCID: PMC483539  PMID: 708515

Abstract

The role of the renin angiotensin system was evaluated in 18 normotensive patients with chronic congestive heart failure and in 5 controls. No correlation was observed between plasma renin activity and cardiac index. There was a significant inverse correlation between renin and pulmonary capillary wedge pressure (r = -0.61, P less than 0.01). Renin values of the patients appeared to be increased when compared with controls with similar left ventricular filling pressure. Specific angiotensin II inhibition by saralasin decreased arterial pressure in 8 out of 14 patients: their renin was significantly higher than that of the remaining 6 patients (P less than 0.01). The 2 patients with the lowest renin levels responded to saralasin with a blood pressure increase. Left ventricular filling pressure decreased in all but these latter 2 patients with either little change or an increase in stroke volume. Thus, renin levels appear to be increased in normotensive patients with congestive heart failure when related to left ventricular filling pressure. Renin via angiotensin II plays a role in the blood pressure control of many patients with congestive heart failure. In some patients angiotensin II blockade appears to improve cardiac function by unloading the left ventricle.

Full text

PDF
1134

Selected References

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

  1. BRAUNWALD E., ROSS J., Jr The ventricular end-diastolic pressure. Appraisal of its value in the recognition of ventricular failure in man. Am J Med. 1963 Feb;34:147–150. doi: 10.1016/0002-9343(63)90049-4. [DOI] [PubMed] [Google Scholar]
  2. Brown J. J., Davies D. L., Johnson V. W., Lever A. F., Robertson J. I. Renin relationships in congestive cardiac failure, treated and untreated. Am Heart J. 1970 Sep;80(3):329–342. doi: 10.1016/0002-8703(70)90098-0. [DOI] [PubMed] [Google Scholar]
  3. Brunner H. R., Gavras H., Laragh J. H. Specific inhibition of the renin-angiotensin system: A key to understanding blood pressure regulation. Prog Cardiovasc Dis. 1974 Sep-Oct;17(2):87–98. doi: 10.1016/0033-0620(74)90024-3. [DOI] [PubMed] [Google Scholar]
  4. Case D. B., Wallace J. M., Keim H. J., Weber M. A., Drayer J. I., White R. P., Sealey J. E., Laragh J. H. Estimating renin participation in hypertension: superiority of converting enzyme inhibitor over saralasin. Am J Med. 1976 Nov;61(5):790–796. doi: 10.1016/0002-9343(76)90160-1. [DOI] [PubMed] [Google Scholar]
  5. Chatterjee K., Parmley W. W., Ganz W., Forrester J., Walinsky P., Crexells C., Swan H. J. Hemodynamic and metabolic responses to vasodilator therapy in acute myocardial infarction. Circulation. 1973 Dec;48(6):1183–1193. doi: 10.1161/01.cir.48.6.1183. [DOI] [PubMed] [Google Scholar]
  6. Chatterjee K., Parmley W. W. The role of vasodilator therapy in heart failure. Prog Cardiovasc Dis. 1977 Jan-Feb;19(4):301–325. doi: 10.1016/0033-0620(77)90006-8. [DOI] [PubMed] [Google Scholar]
  7. Cohn J. N., Mathew K. J., Franciosa J. A., Snow J. A. Chronic vasodilator therapy in the management of cardiogenic shock and intractable left ventricular failure. Ann Intern Med. 1974 Dec;81(6):777–780. doi: 10.7326/0003-4819-81-6-777. [DOI] [PubMed] [Google Scholar]
  8. DOLLERY C. T., HILL D. W., HODGE J. V. The response of normal retinal blood vessels to angiotensin and noradrenaline. J Physiol. 1963 Mar;165:500–507. doi: 10.1113/jphysiol.1963.sp007073. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Davis J. O., Freeman R. H. Mechanisms regulating renin release. Physiol Rev. 1976 Jan;56(1):1–56. doi: 10.1152/physrev.1976.56.1.1. [DOI] [PubMed] [Google Scholar]
  10. EMERSON T. E., Jr, HINSHAW L. B., BRAKE C. M. VASCULAR EFFECTS OF ANGIOTENSIN AND NOREPINEPHRINE IN THE DOG, CAT, AND MONKEY. Am J Physiol. 1965 Feb;208:260–264. doi: 10.1152/ajplegacy.1965.208.2.260. [DOI] [PubMed] [Google Scholar]
  11. Ferguson R. K., Turini G. A., Brunner H. R., Gavras H., McKinstry D. N. A specific orally active inhibitor of angiotensin-converting enzyme in man. Lancet. 1977 Apr 9;1(8015):775–778. doi: 10.1016/s0140-6736(77)92958-0. [DOI] [PubMed] [Google Scholar]
  12. Franciosa J. A., Limas C. J., Guiha N. H., Rodriguera E., Cohn J. N. Improved left ventricular function during nitroprusside infusion in acute myocardial infarction. Lancet. 1972 Mar 25;1(7752):650–654. doi: 10.1016/s0140-6736(72)90460-6. [DOI] [PubMed] [Google Scholar]
  13. Gavras H., Brunner H. B., Vaughan E. D., Laragh J. H. Angiotensin-sodium interaction in blood pressure maintenance of renal hypertensive and normotensive rats. Science. 1973 Jun 29;180(4093):1369–1371. doi: 10.1126/science.180.4093.1369. [DOI] [PubMed] [Google Scholar]
  14. Gavras H., Brunner H. R., Laragh J. H., Sealey J. E., Gavras I., Vukovich R. A. An angiotensin converting-enzyme inhibitor to identify and treat vasoconstrictor and volume factors in hypertensive patients. N Engl J Med. 1974 Oct 17;291(16):817–821. doi: 10.1056/NEJM197410172911603. [DOI] [PubMed] [Google Scholar]
  15. Gavras H., Ribeiro A. B., Gavras I., Brunner H. R. Reciprocal relation between renin dependency and sodium dependency in essential hypertension. N Engl J Med. 1976 Dec 2;295(23):1278–1283. doi: 10.1056/NEJM197612022952302. [DOI] [PubMed] [Google Scholar]
  16. Gold H. K., Leinbach R. C., Sanders C. A. Use of sublingual nitroglycerin in congestive failure following acute myocardial infarction. Circulation. 1972 Nov;46(5):839–845. doi: 10.1161/01.cir.46.5.839. [DOI] [PubMed] [Google Scholar]
  17. Gould L., Reddy C. V., Kalanithi P., Espina L., Gomprecht R. F. Use of phentolamine in acute myocardial infarction. Am Heart J. 1974 Aug;88(2):144–148. doi: 10.1016/0002-8703(74)90003-9. [DOI] [PubMed] [Google Scholar]
  18. KOCH-WESER J. NATURE OF THE INOTROPIC ACTION OF ANGIOTENSIN ON VENTRICULAR MYOCARDIUM. Circ Res. 1965 Mar;16:230–237. doi: 10.1161/01.res.16.3.230. [DOI] [PubMed] [Google Scholar]
  19. Kovick R. B., Tillisch J. H., Berens S. C., Bramowitz A. D., Shine K. I. Vasodilator therapy for chronic left ventricular failure. Circulation. 1976 Feb;53(2):322–328. doi: 10.1161/01.cir.53.2.322. [DOI] [PubMed] [Google Scholar]
  20. Miller R. R., Vismara L. A., Williams D. O., Amsterdam E. A., Mason D. T. Pharmacological mechanisms for left ventricular unloading in clinical congestive heart failure. Differential effects of nitroprusside, phentolamine, and nitroglycerin on cardiac function and peripheral circulation. Circ Res. 1976 Jul;39(1):127–133. doi: 10.1161/01.res.39.1.127. [DOI] [PubMed] [Google Scholar]
  21. Morris B. J., Davis J. O., Zatzman M. L., Williams G. M. The renin-angiotensin-aldosterone system in rabbits with congestive heart failure produced by aortic constriction. Circ Res. 1977 Mar;40(3):275–282. doi: 10.1161/01.res.40.3.275. [DOI] [PubMed] [Google Scholar]
  22. Nicholls M. G., Espiner E. A., Donald R. A., Hughes H. Aldosterone and its regulation during diuresis in patients with gross congestive heart failure. Clin Sci Mol Med. 1974 Oct;47(4):301–315. doi: 10.1042/cs0470301. [DOI] [PubMed] [Google Scholar]
  23. Nicholls M. G., Espiner E. A., Hughes H., Rogers T. Effect of potassium-sparing diuretics on the renin-angiotensin-aldosterone system and potassium retention in heart failure. Br Heart J. 1976 Oct;38(10):1025–1030. doi: 10.1136/hrt.38.10.1025. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Ondetti M. A., Rubin B., Cushman D. W. Design of specific inhibitors of angiotensin-converting enzyme: new class of orally active antihypertensive agents. Science. 1977 Apr 22;196(4288):441–444. doi: 10.1126/science.191908. [DOI] [PubMed] [Google Scholar]
  25. Ondetti M. A., Williams N. J., Sabo E. F., Pluscec J., Weaver E. R., Kocy O. Angiotensin-converting enzyme inhibitors from the venom of Bothrops jararaca. Isolation, elucidation of structure, and synthesis. Biochemistry. 1971 Oct 26;10(22):4033–4039. doi: 10.1021/bi00798a004. [DOI] [PubMed] [Google Scholar]
  26. Pals D. T., Masucci F. D., Sipos F., Denning G. S., Jr A specific competitive antagonist of the vascular action of angiotensin. II. Circ Res. 1971 Dec;29(6):664–672. doi: 10.1161/01.res.29.6.664. [DOI] [PubMed] [Google Scholar]
  27. Perret C. l., Gardaz J. P., Reynaert M., Grimbert F., Enrico J. F. Phentolamine for vasodilator therapy in left ventricular failure complicating acute myocardial infarction. Haemodynamic study. Br Heart J. 1975 Jun;37(6):640–646. doi: 10.1136/hrt.37.6.640. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Posternak L., Brunner H. R., Gavras H., Brunner D. B. Angiotensin II blockade in normal man: interaction of renin and sodium in maintaining blood pressure. Kidney Int. 1977 Mar;11(3):197–203. doi: 10.1038/ki.1977.28. [DOI] [PubMed] [Google Scholar]
  29. Sancho J., Re R., Burton J., Barger A. C., Haber E. The role of the renin-angiotensin-aldosterone system in cardiovascular homeostasis in normal human subjects. Circulation. 1976 Mar;53(3):400–405. doi: 10.1161/01.cir.53.3.400. [DOI] [PubMed] [Google Scholar]
  30. Sealey J. E., Gerten-Banes J., Laragh J. H. The renin system: Variations in man measured by radioimmunoassay or bioassay. Kidney Int. 1972 Apr;1(4):240–253. doi: 10.1038/ki.1972.34. [DOI] [PubMed] [Google Scholar]
  31. Streeten D. H., Anderson G. H., Jr, Dalakos T. H. Angiotensin blockade: its clinical significance. Am J Med. 1976 May 31;60(6):817–824. doi: 10.1016/0002-9343(76)90894-9. [DOI] [PubMed] [Google Scholar]
  32. Watkins L., Jr, Burton J. A., Haber E., Cant J. R., Smith F. W., Barger A. C. The renin-angiotensin-aldosterone system in congestive failure in conscious dogs. J Clin Invest. 1976 Jun;57(6):1606–1617. doi: 10.1172/JCI108431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Zehr J. E., Hasbargen J. A., Kurz K. D. Reflex suppression of renin secretion during distention of cardiopulmonary receptors in dogs. Circ Res. 1976 Apr;38(4):232–239. doi: 10.1161/01.res.38.4.232. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES