Biomedical subjects

B Waeber

Publications and source records attributed to B Waeber.

At least 307 records · Page 17Linked to original sources

PubMed1987

Lack of a role of circulating bradykinin in the blood pressure response to acute angiotensin converting enzyme inhibition in rats.

The role of circulating bradykinin in blood pressure regulation was investigated in conscious normotensive rats using a competitive antagonist of bradykinin. The acute blood pressure effect of this antagonist was also evaluated after inhibition of angiotensin converting enzyme with captopril and during simultaneous infusion of exogenous angiotensin II. No evidence was found for a role of circulating bradykinin in rats studied under normal conditions. Endogenous bradykinin seemed however involved in blood pressure control during angiotensin II infusion. Acute angiotensin converting enzyme inhibition had no influence on the blood pressure response to the bradykinin antagonist.

Angiotensin II↗

PubMed1987

[Non-invasive methods of evaluation in hypertensive patients].

Major strides have been made, in the past few years, in the field of arterial hypertension, due to the availability of methods permitting a non-invasive, and precise evaluation, outside of the office, of the blood pressure as well as the cardiac response to chronic pressure surcharge. The devices used to record pressure profiles, in an ambulatory situation, are periodically activated, either automatically or by the patient himself. They are portable blood pressure recorders connected to a conventional inflatable arm cuff. The arterial blood pressure thus measured may be quite different from that measured by a physician. The value of the arterial blood pressure recorded in ambulatory is not predictable on the basis of the values obtained in a medical environment. An important factor is that the risk of cardiovascular complication seems to be better correlated to the blood pressure measurements obtained in the usual patient's environment than to those taken by the physician. Sonocardiography is another non-invasive method allowing a better screening of the patients likely to benefit from an antihypertensive treatment. A left ventricular hypertrophy may be detected quite early in an hypertensive patient. The regression of such anomaly under antihypertensive treatment permits to ascertain the good quality of the blood pressure control obtained with antihypertensive medications.

Ambulatory Care↗

PubMed1987

[ACE inhibitors and their clinical significance].

With the availability of orally active angiotensin converting enzyme (ACE) inhibitors, it has become possible to chronically inhibit the renin-angiotensin system. When given to hypertensive patients as monotherapy, these agents can normalize the blood pressure in about 50% of all cases like other antihypertensive drugs. If the monotherapy is not sufficient to normalize blood pressure, the addition of a sodium depletion, for instance by administering concomitantly a diuretic, can become necessary to normalize blood pressure. The antihypertensive effect of ACE inhibitors is characterized by some particularly favorable features: ACE inhibitors attenuate the fall in serum potassium and the rise in plasma uric acid induced by diuretics, they do not cause any salt retention nor orthostatic hypotension, they do not raise pulse rate when they reduce blood pressure, and they certainly do not reduce the perfusion rate of the brain, the heart or the kidneys. The same features are apparent when using these agents in patients with congestive heart failure, in whom these drugs enhance cardiac output and exercise capacity by decreasing simultaneously pre- and afterload to the heart. Untoward effects of ACE inhibitors are relatively infrequent and they can mostly be foreseen based on an understanding of the pharmacological mechanisms of these compounds. Thus, with appropriate use, untoward effects are often completely avoided. Recent clinical studies have suggested that ACE inhibitors, when compared to other antihypertensive drugs, can improve the quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1987

Nicotine-induced release of vasopressin in the conscious rat: role of opioid peptides and hemodynamic effects.

Nicotine has been shown to stimulate the release of vasopressin and to cause significant hemodynamic changes. The mechanisms leading to enhanced vasopressin secretion and the vascular consequences of the high plasma vasopressin levels during nicotine infusion have not yet been determined. Therefore, the purposes of the present study were 1) to examine in normal conscious rats the role of opioid peptides in the nicotine-induced increase in plasma vasopressin levels and 2) to assess the role of vasopressin in the hemodynamic effects of nicotine (20 micrograms/min for 15 min) using a specific V1 antagonist of the vascular actions of vasopressin. Plasma vasopressin levels were significantly increased in the nicotine-treated animals (39.5 +/- 10 vs. 3.7 +/- 0.6 pg/ml in the controls, P less than .01). Pretreatment with naloxone, an antagonist of opioids at their receptors, did not reduce the vasopressin levels (47.7 +/- 9 pg/ml). Nicotine also increased mean blood pressure (122.5 +/- 2.5 to 145.2 +/- 3.3 mm Hg, P less than .01) and decreased heart rate (461 +/- 6 to 386 +/- 14.5 beats/min, P less than .05). Administration of the vasopressin V1 antagonist before the nicotine infusion did not affect the systemic hemodynamics or the regional blood flow distribution, as assessed by radiolabeled microspheres. Thus, these results suggest that the nicotine-induced secretion of vasopressin is not mediated by opioid receptors and that the high plasma vasopressin levels do not exert any significant hemodynamic effect on cardiac output or blood flow distribution.

Animals↗

PubMed1986

Neuropeptide Y normalizes renin secretion in adrenalectomized rats without changing blood pressure.

In the periphery, neuropeptide Y is present in plasma, in the adrenal medulla as well as in sympathetic nerve endings and in the juxtaglomerular apparatus. The aim of the present study was to assess the effect of this peptide on renin secretion. Normotensive rats were adrenalectomized or sham-operated and made hypertensive with methylprednisolone acetate (20 mg/kg s.c. once weekly). Deoxycorticosterone pivalate (10 mg/kg s.c. once weekly) was also given to prevent mineralocorticoid deficiency. Two weeks after initial surgery, 12 adrenalectomized and 8 sham-operated conscious rats were infused for 30 min with neuropeptide Y (0.1 micrograms/min) whereas 8 other adrenalectomized and 9 sham-operated conscious rats received under similar conditions the vehicle of neuropeptide Y (10 microliter/min). Neither before nor during the infusions was there a significant difference in blood pressure and heart rate between the 4 groups of animals. Plasma renin activity, measured at the end of the infusion, was 30.5 ng/ml/hr in the adrenalectomized group receiving vehicle and 6.3 ng/ml/hr in that infused with neuropeptide Y (p less than 0.001). This latter value did not differ from that found in sham-operated rats. These results suggest that neuropeptide Y may play an important role in regulating renin secretion.

Adrenalectomy↗

PubMed1986

[Effects of perfusion of human atrial natriuretic factor in normal volunteers].

The renal and systemic effects of a synthetic atrial natriuretic peptide (ANP) corresponding to the sequence of the human hormone was investigated in normal volunteers. Each subject was infused for 4 hours on 3 different days at a one week interval with either ANP (0.5 or 1 microgram/min) or its vehicle. ANP enhanced natriuresis without simultaneously modifying glomerular filtration rate. ANP did, however, reduce effective renal plasma flow. In spite of the increased natriuresis, the activity of the renin-angiotensin-aldosterone system was reduced during ANP infusion. ANP induced a transient increase in skin blood flow. No change in blood pressure and heart rate occurred in the course of the experiment.

Adult↗

PubMed1986

[Vasopressin in acute myocardial infarct: clinical implications].

Since current data on vasopressin (AVP) secretion during the early phase of myocardial infarction is not extensive, plasma AVP was measured in 26 patients with acute myocardial infarction. Twelve had an increased AVP concentration (23.2 +/- 7.0 pg/ml; mean +/- SEM) whereas 14 had an AVP level less than 3 pg/ml (1.96 +/- 0.14 pg/ml). The patients with AVP greater than 3 pg/ml had higher heart rate and plasma osmolality than those with AVP less than 3 pg/ml. Blood pressure values were the same in both groups of patients. There was no difference in peak CPK and iso CPK activities between the two groups. Seven patients with AVP greater than 3 pg/ml died within the next few days, while only 1 patient with AVP less than pg/ml died. It thus appears that increased AVP concentration during acute myocardial infarction is associated with a poor prognosis. Whether it is a cause or a consequence of an unfavourable course of myocardial infarction remains to be determined.

Adult↗

PubMed1986

The hemodynamic response of conscious normotensive rats to atriopeptin III: Lack of a role of the parasympathetic nervous system.

The influence of the parasympathetic nervous system on the cardiovascular response to a synthetic atrial peptide (atriopeptin III) was examined in conscious normotensive rats by utilizing radiolabelled microspheres. Atriopeptin III was infused intravenously for 30 min at a rate of 1 microgram/min per rat in animals pretreated with a bolus intravenous injection of atropine, (150 micrograms/rat, n = 8) or of its vehicle (n = 8). Additional animals (n = 9) received the vehicle of both atropine and atriopeptin III. The atrial peptide decreased mean blood pressure to a similar extent in rats pretreated with atropine (from 124 +/- 4.5 to 108 +/- 5.3 mm Hg, mean +/- S.E.M., P less than 0.05) and in the controls (from 123 +/- 3.8 to 105 +/- 3.8 mm Hg, P less than 0.05). Heart rate rose significantly after administration of atropine. After the 30 min infusion, the cardiac index was significantly lower (P less than 0.05) in both groups infused with atriopeptin III (23.7 +/- 2.3 after atropine pretreatment and 25.1 +/- 2.2 ml X min-1 X 100 g-1 without atropine) than in the group of rats given only the vehicle of both atropine and atriopeptin III (32.4 +/- 2.8 ml X min-1 X 100 g-1). Calculated systemic vascular resistance tended to be higher in the former two groups than in the latter. There was no significant difference in regional blood flow distribution within the three groups of rats. These data therefore indicate that in conscious rats atriopeptin III reduces blood pressure and cardiac output without concomitantly diminishing total peripheral vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1986

Atrial natriuretic peptides: reproducibility of renal effects and response of liver blood flow.

To assess the variability of the response to exogenous atrial natriuretic peptide (ANP), it was infused at the rate of 1 microgram/min for 2 h in 6 salt-loaded normal volunteers under controlled conditions on 2 occasions at an interval of 1 week. The effect on solute excretion and the haemodynamic and endocrine actions were highly reproducible. The constant ANP infusion caused a delayed and prolonged excretion of sodium, chloride and calcium, no change in potassium or phosphate excretion or in glomerular filtration rate but a marked decrease in renal plasma flow. Blood pressure, heart rate and the plasma levels of angiotensin II, aldosterone, arginine vasopressin and plasma renin activity were unaltered. The effect of a 2-h infusion of ANP 0.5 microgram/min or its vehicle on apparent hepatic blood flow (HBF) was also studied in 14 normal volunteers by measuring the indocyanine green clearance. A 21% decrease in HBF was observed in subjects who received the ANP infusion (p less than 0.01 vs vehicle). Thus, ANP infused at a dose that did not lower blood pressure decreased both renal and liver blood flow in normotensive volunteers. The renal and endocrine responses to ANP were reproducible over a 1-week interval.

Adult↗

PubMed1986

Single and repeated dosing of the converting enzyme inhibitor perindopril to normal subjects.

The new orally active angiotensin converting enzyme (ACE) inhibitor perindopril (S9490-3) was evaluated in 18 normotensive men. In three subjects the pressor response to exogenous angiotensin I was tested. A 8 mg oral dose reduced the pressor response by greater than 80%. Single oral perindopril doses of 2, 4, 8, and 16 mg were given to groups of five subjects each. Eight and 16 mg decreased plasma ACE activity within 4 hours to less than 10% of control; 72 hours later, plasma ACE activity was still reduced by at least 40%. Doses of 4 and 8 mg po once a day were then given for 8 days to two groups of six subjects. Four hours after the first and the last morning doses, plasma angiotensin II, aldosterone, and plasma ACE activity fell significantly, whereas blood angiotensin I and plasma renin activity rose. There was no evidence of drug accumulation. No significant change in blood pressure or heart rate was observed. Thus in normotensive subjects, perindopril seems an effective, orally active, long-lasting ACE inhibitor.

Acetylcholinesterase↗

PubMed1986

Dopaminergic control of aldosterone secretion in hypertensive patients chronically treated with an angiotensin converting enzyme inhibitor.

To investigate whether dopamine plays a role in the regulation of aldosterone secretion during long-term blockade of the renin-angiotensin system, we studied the effect of metoclopramide, a competitive antagonist of dopamine, in 6 patients with essential hypertension chronically treated with the angiotensin converting enzyme inhibitor enalapril. All but one of these patients received a diuretic in addition to enalapril. Six hours after the daily morning dose of enalapril (10-40 mg p.o.) a 10 mg bolus dose of metoclopramide was injected intravenously. In one patient a hypotensive episode developed following metoclopramide administration. In the 5 other patients plasma aldosterone significantly rose within 30 min after metoclopramide from 51 +/- 8.7 to 128.2 +/- 29.2 pg/ml. This metoclopramide-induced release of aldosterone occurred in the absence of concomitant changes in circulating angiotensin 11, potassium and ACTH levels. Metoclopramide given during chronic blockade of the renin-angiotensin system caused anxiety and agitation in 2 patients. The increase in plasma aldosterone following competitive dopamine blockade in the face of chronic angiotensin converting enzyme inhibition, unchanged plasma potassium and ACTH levels strongly suggests that in hypertensive patients, dopamine exerts a direct inhibitory effect on aldosterone secretion.

Adrenocorticotropic Hormone↗

PubMed1986

Octapeptide-specific and sensitive assay for angiotensin II in plasma.

Angiotensin-(1-8)octapeptide (angiotensin II) is the active principle of the renin-angiotensin system. Crossreaction of angiotensin II-antisera with inactive precursors and metabolic fragments prevented the specific quantitation of this hormone in biological fluids. Peptide-extraction on bonded-phase silica followed by peptide-separation using isocratic reverse-phase high performance liquid chromatography and subsequent radioimmunoassay rendered possible the octapeptide-specific measurement of angiotensin II in 2 ml plasma with a detection limit of 0.4 fmol/ml. The coefficient of variation for intra-assay precision was 0.06 and for inter-assay precision 0.13. 125I-angiotensin II was recovered from plasma by solid-phase extraction to 99 +/- 2% (mean +/- S.D.). The overall recovery of 5, 10 and 20 fmol unlabeled angiotensin II added to plasma was 80 +/- 10%. Plasma concentrations in supine normal humans averaged 4.1 +/- 1.6 fmol/ml and were suppressed below the detection limit by angiotensin I converting enzyme inhibition.

Angiotensin II↗

PubMed1986

Chronic treatment of hypertensive patients with converting enzyme inhibitors.

It is widely accepted that pharmacologic reduction of the blood pressure of hypertensive patients reduces the risk of at least some of the major cardiovascular complications (1-5). All major studies were carried out before orally active converting enzyme inhibitors had become available. In other words, very effective antihypertensive drugs have been around for quite some time and have already proven their efficacy. Therefore, the considerable enthusiasm that has developed during the very recent years for the new converting enzyme inhibitors should be evaluated in the light of previously available antihypertensive drugs, the more so, as drugs cheaper than converting enzyme inhibiting agents are presently available. Thus, the increased expense when using this new class of antihypertensive compounds should be justified by a therapeutic gain. When evaluating a class of antihypertensive drugs such as converting enzyme inhibitors, there are basically three main considerations: What is their efficacy in long-term use? This includes the effect on blood pressure, on heart, on hemodynamics, and on blood flow distribution. What are the metabolic effects? What is the effect on sodium and potassium excretion? How are the serum lipids affected by its use? Are there any untoward effects related either to the chemical structure of the compound per se or rather to the approach? In particular, are there any central effects of the drug which can cause discomfort to the patient? The following discussion has the principal aim to review these aspects with chronic use of oral converting enzyme inhibiting agents without, however, even attempting to provide an exhaustive review of the subject.

Angiotensin I↗

PubMed1986

Clinical studies with a vascular vasopressin antagonist.

The effect of circulating arginine vasopressin (AVP) on blood pressure, heart rate, and skin blood flow was assessed in normotensive subjects, mild hypertensive patients, and patients with congestive heart failure, utilizing the specific antagonist of AVP at the vascular receptor level, d(CH2)5Tyr(Me)AVP (5 micrograms/kg i.v.). The renin system of the normal volunteers treated with the AVP antagonist was either intact or acutely blocked with the angiotensin converting-enzyme inhibitor captopril (25 mg p.o.). In some volunteers, the cardiovascular effect of AVP released by Finnish sauna or cigarette smoking was studied. In patients with congestive heart failure, hemodynamic measurements (pressures and cardiac output) were obtained invasively. Acute blockade of AVP vascular receptors produced no cardiovascular effect unless plasma AVP levels were markedly elevated. In our experience, abnormally high circulating AVP appears to be responsible for the decrease in skin blood flow induced by cigarette smoking and to some extent for the maintenance of vascular tone in the rare patients with particularly severe congestive heart failure.

Angiotensin II↗

PubMed1986

Identification and quantitation of angiotensins.

The introduction of pharmacological inhibitors of renin and angiotensin (ANG) converting enzyme in cardiovascular therapy drew new attention to the role of the renin-angiotensin system in regulating circulatory homeostasis. Accurate measurement of very low concentration of the biologically active peptides ANG II and ANG III sometimes in the presence of large amounts of inactive precursors and metabolites is needed. Active and inactive angiotensins have been measured specifically in attomolar quantities by radioimmunoassay after rapid extraction on bonded-phase silica and subsequent high-performance liquid chromatography. ANG II was found to be generated in cold plasma containing conventional inhibitors; it was concluded that renin, converting enzyme, and angiotensinases must be inhibited if physiological ANG concentrations are to be estimated. Modification of the antigen enhanced the specificity of the ANG II antisera. Monoclonal antibodies to ANG II were produced.

Angiotensin II↗

PubMed1986

Blood pressure monitoring for quality assessment of antihypertensive therapy.

Despite many new therapeutic approaches to the treatment of hypertension and new diagnostic methods, the measurement of the most basic parameter, the blood pressure itself, has not changed over many years. The most commonly used method records the blood pressure on a single occasion and it is then assumed that this single reading is representative of the blood pressure of that patient at all times. This paper presents evidence, based on published studies, showing that the single "office" blood pressure reading gives little information about the blood pressure during daily activities. A study in 101 volunteers and a study in 38 patients with hypertension both showed that, not only is the "office" reading not the same as the average of many blood pressure readings made over 24 h using a Remler device, but also that the difference cannot be predicted. In some cases, the "office" pressure is higher and in some cases lower than the Remler blood pressure. This difference may explain the apparent blood pressure lowering effect of placebo. This has been frequently reported when the blood pressure is measured by the physician but ambulatory blood pressure readings have failed to show this effect. Finally, the inaccuracy of the "office" blood pressure may obscure smaller differences between two treatment groups in a clinical trial which could have been clearly demonstrated if the blood pressure had been recorded using an ambulatory method.

Ambulatory Care↗

PubMed1986

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

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.

Adult↗

PubMed1986

Effect of atriopeptin III on hematocrit and volemia of nephrectomized rats.

The effect of a synthetic atrial natriuretic peptide (atriopeptin III) on blood pressure, heart rate, and hematocrit was investigated in conscious, nephrectomized (n = 6), and sham-operated (n = 6) rats. Atriopeptin III infusion (1 microgram/min iv for 30 min) decreased mean blood pressure to a similar extent in nephrectomized [from 122 +/- 5 to 108 +/- 3 (SE) mmHg; P less than 0.01] and in sham-operated rats (from 124 +/- 4 to 103 +/- 2 mmHg; P less than 0.01), whereas it had no significant effect on heart rate. Hematocrit rose similarly in nephrectomized (from 45 +/- 1 to 49 +/- 1%; P less than 0.01) and in sham-operated rats (from 46 +/- 1 to 50 +/- 1%; P less than 0.001). Infusion of the vehicle of atriopeptin III to nephrectomized rats (n = 7) did not change any of these parameters. Plasma volume and red cell mass of nephrectomized rats infused with atriopeptin III was measured by use of radiolabeled albumin and erythrocytes, respectively. A plasma volume contraction of approximately 10% (P less than 0.01) was observed, whereas red cell mass did not change. In an additional group of nephrectomized rats (n = 6), Na nitroprusside was infused intravenously at a rate of 2 micrograms/min for 30 min. Na nitroprusside reduced mean blood pressure from 127 +/- 4 to 106 +/- 3 mmHg (P less than 0.001), but hematocrit remained unchanged (46 +/- 1% before vs. 45 +/- 1% after infusion). In four anesthetized rats with both kidneys and the spleen removed atriopeptin III still raised the hematocrit.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗