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Updated: Sep 2, 2025
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
A double-blind randomised feasibility trial of angiotensin-2 in cardiac surgery
T G Coulson1, L F Miles2, A Serpa Neto3
1Department of Anaesthesiology and Peri-Operative Medicine, Monash University and Alfred Health, Melbourne, Australia.
Abstract:
Acute kidney injury is common after cardiac surgery. Vasoplegic hypotension may contribute to kidney injury, and different vasopressors may have variable effects on kidney function. We conducted a double-blind, randomised feasibility trial comparing peri-operative angiotensin-2 with noradrenaline. We randomly allocated 60 patients at two centres to a blinded equipotent angiotensin-2 or noradrenaline infusion intra-operatively and for up to 48 h postoperatively, titrated to mean arterial pressure of 70-80 mmHg. Primary feasibility outcomes included consent rate, protocol adherence, infusion duration, mean arterial pressure maintenance in the target range and major adverse outcomes. Secondary outcomes included kidney injury rate. The consent rate was 47%. Protocol adherence was 100% in the angiotensin-2 group and 94% in the noradrenaline group. Study drug duration was median (IQR [range]) 217 (160-270 [30-315]) vs. 185 (135-301 [0-480]) min (p = 0.78) min intra-operatively, and 5 (0-16 [0-48]) vs. 14.5 (4.8-29 [0-48]) hours (p = 0.075) postoperatively for angiotensin-2 and noradrenaline, respectively. The mean arterial pressure target was achieved postoperatively in 25 of 28 (89%) of the angiotensin-2 group and 27 of 32 (84%) of the noradrenaline group. One participant had a stroke, one required extracorporeal support and three required renal replacement therapy, all in the noradrenaline group (p = 0.99, p = 0.99 and p = 0.1). Acute kidney injury occurred in 7 of 28 in the angiotensin-2 group vs. 12 of 32 patients in the noradrenaline group (p = 0.31). This pilot study suggests that a trial comparing angiotensin-2 with noradrenaline is feasible. Its findings justify further investigations of angiotensin-2 in cardiac surgery.
Insights
This study found that comparing angiotensin-2 with noradrenaline in cardiac surgery patients is feasible. Further research is warranted to investigate angiotensin-2 for preventing acute kidney injury.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Acute kidney injury (AKI) is a frequent complication following cardiac surgery.
- Vasoplegic hypotension, a common post-operative condition, may exacerbate kidney injury.
- The choice of vasopressor may influence kidney function outcomes.
Purpose of the Study:
- To assess the feasibility of a randomized trial comparing peri-operative angiotensin-2 with noradrenaline.
- To evaluate the efficacy of angiotensin-2 versus noradrenaline in maintaining blood pressure and potentially reducing AKI.
Main Methods:
- A double-blind, randomized feasibility trial involving 60 cardiac surgery patients.
- Patients received either angiotensin-2 or noradrenaline infusions, titrated to maintain mean arterial pressure between 70-80 mmHg.
- Feasibility outcomes included consent rate, protocol adherence, and drug infusion duration; kidney injury rate was a secondary outcome.
Main Results:
- The consent rate was 47%.
- Both angiotensin-2 and noradrenaline effectively maintained the target mean arterial pressure.
- While not statistically significant, the angiotensin-2 group showed a trend towards lower AKI rates (7/28 vs. 12/32).
Conclusions:
- This pilot study demonstrates the feasibility of conducting a larger trial comparing angiotensin-2 and noradrenaline.
- Findings suggest angiotensin-2 may be a viable alternative for managing vasoplegic hypotension in cardiac surgery, potentially impacting AKI.
- Further investigation into angiotensin-2's role in preventing AKI post-cardiac surgery is justified.
