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Related Experiment Videos

Captopril does not prevent nitroglycerin tolerance in heart failure.

J Dupuis1, G Lalonde, D Bichet

  • 1Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, Québec.

The Canadian Journal of Cardiology
|September 1, 1990
PubMed
Summary

Captopril did not prevent tolerance to nitroglycerin infusions in heart failure patients. Combining captopril and nitroglycerin did not worsen renal function during the 72-hour study.

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Area of Science:

  • Cardiovascular Pharmacology
  • Nephrology
  • Clinical Therapeutics

Background:

  • Nitroglycerin tolerance may stem from reduced vascular responsiveness and reflex neurohumoral activation.
  • Angiotensin converting enzyme (ACE) inhibitors like captopril, containing sulfhydryl groups, were hypothesized to prevent nitroglycerin tolerance.
  • Concerns existed that combining captopril and nitrates could impair renal function due to reduced perfusion pressure.

Purpose of the Study:

  • To evaluate if captopril prevents or reduces hemodynamic tolerance to continuous nitroglycerin infusion.
  • To assess the impact of combined nitroglycerin and captopril therapy on renal function.

Main Methods:

  • Nineteen congestive heart failure patients received 72-hour infusions of nitroglycerin alone or with oral captopril.

Related Experiment Videos

  • Hemodynamic tolerance and renal function parameters (creatinine clearance, sodium excretion) were monitored.
  • Plasma levels of neurohumoral factors (adrenaline, renin, vasopressin, ANP) were analyzed.

    • Main Results:

    • Partial hemodynamic tolerance to nitroglycerin developed within 24 hours in both groups.
    • Neither nitroglycerin alone nor in combination with captopril altered plasma adrenaline, noradrenaline, aldosterone, or vasopressin.
    • Plasma renin activity increased and atrial natriuretic peptide decreased initially, returning towards baseline in both groups; renal function remained stable.

    Conclusions:

    • Captopril did not prevent the development of partial hemodynamic tolerance to nitroglycerin.
    • The combination of nitroglycerin and captopril did not lead to renal dysfunction in these patients.
    • Further research may be needed to explore alternative strategies for mitigating nitroglycerin tolerance.