CHRONIC RENAL AND NEUROHUMORAL EFFECTS OF THE CALCIUM ENTRY BLOCKER NISOLDIPINE IN PATIENTS WITH CONGESTIVE-HEART-FAILURE
CHRONIC RENAL AND NEUROHUMORAL EFFECTS OF THE CALCIUM ENTRY BLOCKER NISOLDIPINE IN PATIENTS WITH CONGESTIVE-HEART-FAILURE
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DOI：
10.1016/s0735-1097(87)80057-8
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发表时间：
1987-03-01
影响因子：
24
通讯作者：
DECHAMPLAIN, J
中科院分区：
文献类型：
--
作者：
BARJON, JN;ROULEAU, JL;DECHAMPLAIN, J
Nisoldipine, a calcium entry blocker, was given to 10 patients with congestive heart failure. During a 2 month follow-up period, 7 of the 10 patients were readmitted with pulmonary edema; daily furosemide doses were increased (128 .+-. 87 to 192 .+-. 135 mg/day, p < 0.01), and plasma creatinine increased (1.5 .+-. 0.5 to 1.8 .+-. 0.6 mg/dl, p < 0.05) (all values mean .+-. SD). Despite this unfavorable clinical course, nisoldipine caused some beneficial chronic (1 month) hemodynamic effects. It decreased systemic vascular resistance (from 1,781 .+-. 229 to 1,306 .+-. 345 dynes.cntdot.s.cntdot.cm-5, p < 0.01), decreased mean arterial pressure (from 88 .+-. 0 to 74 .+-. 4 mm Hg, p < 0.001) and increased stroke volume index (from 27 .+-. 6 to 33 .+-. 9 ml/min per m2, p < 0.02). Heart rate, pulmonary capillary wedge pressure and stroke work index did not change. However, nisoldipine''s chronic renal and neurohumoral effects were not as favorable. These were assessed during a 5 hour water load (15 ml/kg body weight of 5% dextrose in water) and compared with the effects of a water load before therapy. Nisoldipine did not change creatinine clearance or sodium excretion, but decreased water excretion (from 58 .+-. 35 to 46 .+-. 40% of water load in 5 hours). Over this 5 hour study, mean plasma vasopressin was also higher with nisoldipine (1.9 .+-. 2.3 versus 2.7 .+-. 3.2 pg/ml, p < 0.05), but mean plasma aldosterone was lower (67 .+-. 31 to 47 .+-. 27 mg/dl, p < 0.05). During the 5 hour water load, plasma renin activity increased (from 3.3 .+-. 1.6 to 5.6 .+-. 3.9 ng/ml per hour, p < 0.05) as did plasma norepinephrine (from 615 .+-. 384 to 744 .+-. 494 pg/ml, p < 0.05) with nisoldipine, whereas during the control water load, plasma renin activity tended to decrease and the increase in plasma norepinephrine was not as sustained. It is concluded that by causing further neurohumoral activation, nisoldipine may worsen the symptoms of congestive heart failure.
