Vasopressor response to angiotensin II infusion in patients with chronic heart failure receiving beta-blockers.
Vasopressor response to angiotensin II infusion in patients with chronic heart failure receiving beta-blockers.
复制标题
接受 β 受体阻滞剂治疗的慢性心力衰竭患者对血管紧张素 II 输注的血管升压反应。
DOI：
10.1161/01.cir.0000045666.04794.14
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发表时间：
2003
期刊：
影响因子：
37.8
通讯作者：
Jorde,UlrichP
中科院分区：
文献类型：
--
作者：
Vittorio,TimothyJ;Lang,ChimC;Katz,StuartD;Packer,Milton;Mancini,DonnaM;Jorde,UlrichP
背景：血管紧张素II (Ang II) 1型受体和α1-肾上腺素能受体之间的协同相互作用已经被描述。我们假设非选择性β-拮抗剂卡维地洛通过其α1-肾上腺素能阻断特性，可能调节慢性心力衰竭（CHF）患者血管对Ang II的反应性。因此，我们比较了卡维地洛和美托洛尔（一种选择性β拮抗剂）治疗的患者对输注Ang II的血管加压反应。方法与结果：所有患者均给予卡维地洛或美托洛尔治疗至少3个月。ACE抑制剂治疗标准为依那普利40mg /d或最大耐受剂量。外源性Ang II被连续静脉注射（2.5至30 ng/kg）至桡动脉收缩压升高≥20 mm Hg。引起桡动脉收缩压（PD20）变化20 mm Hg所需的Ang II剂量定义了对Ang II的血管升压反应。研究对象为20例CHF患者（平均左室射血分数28±9%，纽约心脏协会II级[n=13]和III级[n=7]）。血浆Ang II水平与PD20无相关性。然而，卡维地洛治疗组的PD20明显高于美托洛尔治疗组（20[范围2.5至30]对5[范围2.5至10]ng/kg，P=0.019）。结论卡维地洛治疗组血管升压反应明显低于美托洛尔治疗组。这是否由于α - 1肾上腺素能阻滞或卡维地洛的其他辅助特性，有待进一步研究。
Background—A synergistic interaction between the angiotensin II (Ang II) type 1 receptor and α1-adrenergic receptors has been described. We hypothesized that the nonselective β-antagonist carvedilol, through its α1-adrenergic blocking properties, may modulate vascular reactivity to Ang II in patients with chronic heart failure (CHF). Accordingly, we compared the vasopressor response to infused Ang II in patients treated with carvedilol and metoprolol, a selective β-antagonist.Methods and Results—All subjects were treated with carvedilol or metoprolol for at least 3 months. ACE inhibitor therapy was standardized to enalapril 40 mg/d or the maximally tolerated dose. Exogenous Ang II was administered as sequential intravenous bolus injections (2.5 to 30 ng/kg) titrated to a rise in radial artery systolic pressure of ≥20 mm Hg. The dose of Ang II required to elicit a change of 20 mm Hg in radial artery systolic pressure (PD20) defined the vasopressor response to Ang II. Twenty subjects with CHF (mean left ventricular ejection fraction 28±9%, New York Heart Association class II [n=13] and III [n=7]) were studied. There was no correlation between plasma Ang II levels and PD20. However, the PD20 was significantly higher in patients treated with carvedilol than in those treated with metoprolol (20 [range 2.5 to 30] versus 5 [range 2.5 to 10] ng/kg,P=0.019).Conclusions—The vasopressor response to Ang II infusion in patients treated with carvedilol was significantly lower than in patients treated with metoprolol. Whether this is due to the α1-adrenergic blocking or other ancillary properties of carvedilol warrants further investigation.