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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
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Angiotensin II Infusion for Shock: A Multicenter Study of Postmarketing Use
Patrick M Wieruszewski1, Erica D Wittwer2, Kianoush B Kashani3
1Department of Pharmacy, Mayo Clinic, Rochester, MN; Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN.
Chest
|September 4, 2020
Summary
Synthetic angiotensin II effectively treated refractory vasodilatory shock in 67% of patients. Lower lactate levels and vasopressin use predicted a favorable response, which was associated with reduced 30-day mortality.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Cardiovascular Research
Background:
- Vasodilatory shock unresponsive to standard vasopressors carries high mortality.
- Synthetic angiotensin II offers a potent vasoconstrictive alternative for managing such cases.
Purpose of the Study:
- To evaluate the safety and effectiveness of synthetic angiotensin II in patients with vasodilatory shock.
- To identify factors associated with a positive hemodynamic response to angiotensin II.
Main Methods:
- A multicenter, retrospective study involving 270 patients with vasodilatory shock.
- Hemodynamic responsiveness was defined as achieving a mean arterial pressure (MAP) ≥ 65 mm Hg with stable or reduced vasopressor dosage within 3 hours of angiotensin II initiation.
Main Results:
- 67% of patients (181/270) responded hemodynamically to angiotensin II.
- Responders exhibited significantly greater MAP increase and vasopressor reduction compared to non-responders.
- Lower lactate concentrations and prior vasopressin administration were predictors of favorable response.
- Angiotensin II responsiveness correlated with a reduced risk of 30-day mortality (HR 0.50).
- Adverse events included arrhythmias (10%) and venous thromboembolism (VTE) (4 patients).
Conclusions:
- Synthetic angiotensin II is effective in a majority of patients with refractory vasodilatory shock.
- Predictors of response include lower lactate levels and concurrent vasopressin use.
- Successful hemodynamic response to angiotensin II is linked to improved survival outcomes.
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