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Peripheral haemodynamic effects of perindopril compared in patients with congestive heart failure and in normal
C Thuillez1, C Richard, C Richer
1Services de Pharmacologie Clinique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Perindopril significantly improved blood flow and vascular resistance in heart failure patients. The drug normalized brachial artery diameter, indicating enhanced peripheral hemodynamics.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Physiology
Background:
- Congestive heart failure (CHF) patients exhibit impaired peripheral hemodynamics, including reduced brachial artery blood flow and diameter, and elevated forearm vascular resistance.
- The renin-angiotensin system is implicated in vasoconstriction within CHF, affecting both large arteries and arterioles.
Purpose of the Study:
- To investigate the effects of perindopril on brachial artery blood flow, diameter, and forearm vascular resistance in normal subjects and CHF patients.
- To compare the hemodynamic responses to perindopril between normal individuals and those with severe CHF.
Main Methods:
- A study involving six normal subjects and 10 CHF patients (New York Heart Association class III or IV).
- Administration of perindopril (4 mg orally) and assessment of brachial artery parameters using pulsed Doppler.
- Measurement of forearm vascular resistance and correlation with basal plasma noradrenaline levels.
Main Results:
- Perindopril increased brachial artery blood flow and decreased forearm vascular resistance in both groups.
- These effects were more pronounced in CHF patients, with a significant increase in brachial artery diameter.
- While normalized, brachial artery blood flow in CHF patients remained below baseline values of normal subjects post-perindopril administration.
- A correlation was observed between the decrease in forearm vascular resistance and basal plasma noradrenaline.
Conclusions:
- The renin-angiotensin system plays a critical role in vasoconstriction in CHF patients.
- Perindopril effectively improves peripheral hemodynamics in CHF by addressing both large artery and arteriolar vasoconstriction.
- The observed hemodynamic improvements are linked to the initial sympathetic tone and basal plasma noradrenaline levels.
Abstract:
The effects of perindopril, 4 mg orally, on brachial artery blood flow and diameter (pulsed Doppler) and on forearm vascular resistance were investigated and compared in six normal subjects and 10 congestive heart failure patients (New York Heart Association class III or IV). Pre-drug values of brachial artery blood flow and diameter were significantly lower in patients with congestive heart failure than in normal subjects, the reverse being true for forearm vascular resistance. In normal subjects perindopril increased brachial artery blood flow and decreased forearm vascular resistance, while in patients with congestive heart failure the same effects were observed but they were more pronounced and brachial artery diameter was increased. In patients with congestive heart failure, when perindopril effects were maximal, brachial artery blood flow remained below the baseline values of normal subjects but brachial artery diameter was normalized. Finally, there was a correlation between the drug-induced decrease in forearm vascular resistance and basal plasma noradrenaline values in all subjects taken together. These results indicate that: (1) the renin-angiotensin system plays a major role in vasoconstriction in patients with congestive heart failure; (2) this vasoconstriction affects both large arteries and arterioles; (3) perindopril is able to considerably improve peripheral haemodynamics in congestive heart failure; and (4) this improvement is linked to the initial sympathetic tone.