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      Renal and Adrenal Resistance against Atrial Natriuretic Peptide in Congestive Heart Failure: Effect of Angiotensin I-Converting-Enzyme Inhibition

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          Abstract

          We compared the natriuretic and diuretic effect of an intravenous infusion of 1–28 human atrial natriuretic peptide (hANP) (0.1 µg/kg/min over 30 min) in 10 patients with congestive heart failure (CHF) and in 10 control subjects of similar age and sex. In the controls, urine volume rose from 36.8 ± 8.55 to 115.6 ± 34.2 ml/30 min and urinary sodium excretion from 4.55 ± 0.8 to 11.2 ± 2.24 mEq/30 min before and during the infusion of ANP, respectively. In patients, baseline urine volume and sodium output were similar, however, rise in urine volume and urinary sodium was greatly reduced during the infusion of hANP. In patients with CHF, baseline plasma ANP levels (604.1 ± 135.3 vs. 39.4 ± 5.85 pg/ml;p < 0.005) and urinary excretion of cyclic GMP(cGMP) (41.8 ± 5.22 vs. 15.2 ± 4.19 nmol/30 min; p < 0.05) were significantly elevated compared to controls. The absolute and relative rise in cGMP excretion, however, was blunted in patients with CHF. In the controls, angiotensin I-converting-enzyme (ACE) inhibition by enalapril significantly reduced the urinary output of sodium and water after ANP infusion. Plasma ANP levels and urinary cGMP remained unaltered by ACE inhibition. Furthermore, treatment with enalapril resulted in a rise in renin and a drop in aldosterone levels. The reduction of plasma renin and serum aldosterone by ANP was maintained after ACE inhibiton. In the patient group, administration of enalapril (3 × 2.5 mg every 6 h) reduced ACE activity in the serum from 84.7 ± 16.9 to 2.13 ± 0.88 U/l. Arterial blood pressure was lowered from 114.7 ± 6.69 to 106.1 ± 7.25 mm Hg systolic and from 76.9 ± 3 to 69.2 ± 3.7 mm Hg diastolic. However, natriuresis and diuresis and creatinine clearance following infusion of ANP remained unaltered.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1989
          1989
          12 November 2008
          : 76
          : 6
          : 418-427
          Affiliations
          Medizinische Klinik II der Universität Köln, Krankenanstalten Köln-Merheim, FRG
          Article
          174528 Cardiology 1989;76:418–427
          10.1159/000174528
          2558792
          © 1989 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 10
          Categories
          Original Paper

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