Berglund H, Nyquist O, Beermann B, Jensen-Urstad M, Theodorsson E
Department of Medicine, Huddinge Hospital, Stockholm, Sweden.
Br Heart J. 1994 Dec;72(6):521-7. doi: 10.1136/hrt.72.6.521.
To examine the relation between haemodynamics and atrial natriuretic peptide concentration during short term angiotensin converting enzyme inhibition.
Patients were randomly allocated to receive placebo or one of three doses of the angiotensin converting enzyme inhibitor ramipril.
Cardiac units of two tertiary referral hospitals.
38 Patients with stable congestive heart failure caused by ischaemic heart disease.
Data were collected over a 24 hour period and assessed with the aim of distinguishing between the haemodynamic effects on plasma concentrations of atrial natriuretic peptide and the direct effects of the study drug, vasopressin concentrations, and angiotensin converting enzyme activity.
Pulmonary capillary wedge pressure was the main predictor of the plasma concentration of atrial natriuretic peptide. A higher plasma concentration of this peptide with a given pulmonary capillary wedge pressure was found after 24 hours of treatment with 2.5 mg and 5 mg of ramipril. Plasma concentration of the active metabolite, change in arginine vasopressin concentration or degree of angiotensin converting enzyme inhibition did not significantly predict change in plasma concentration of atrial natriuretic peptide or in the ratio of atrial natriuretic peptide concentration to pulmonary capillary wedge pressure.
A gradual increase in plasma concentration of atrial natriuretic peptide with a given pulmonary capillary wedge pressure, occurs during short term high degree inhibition of angiotensin converting enzyme. The causative mechanisms are yet to be identified. Such a change in the relation between central haemodynamics and atrial natriuretic peptide concentration may contribute to the beneficial effects of angiotensin converting enzyme inhibition in patients with congestive heart failure due to ischaemic heart disease.
研究短期血管紧张素转换酶抑制期间血流动力学与心房利钠肽浓度之间的关系。
患者被随机分配接受安慰剂或三种剂量血管紧张素转换酶抑制剂雷米普利中的一种。
两家三级转诊医院的心脏科。
38例由缺血性心脏病引起的稳定型充血性心力衰竭患者。
在24小时内收集数据，并进行评估，目的是区分血流动力学对心房利钠肽血浆浓度的影响以及研究药物、血管加压素浓度和血管紧张素转换酶活性的直接影响。
肺毛细血管楔压是心房利钠肽血浆浓度的主要预测指标。在用2.5毫克和5毫克雷米普利治疗24小时后，在给定的肺毛细血管楔压下发现该肽的血浆浓度较高。活性代谢物的血浆浓度、精氨酸血管加压素浓度的变化或血管紧张素转换酶抑制程度均不能显著预测心房利钠肽血浆浓度的变化或心房利钠肽浓度与肺毛细血管楔压之比的变化。
在短期高度抑制血管紧张素转换酶期间，在给定的肺毛细血管楔压下，心房利钠肽的血浆浓度会逐渐升高。其致病机制尚待确定。中心血流动力学与心房利钠肽浓度之间关系的这种变化可能有助于血管紧张素转换酶抑制对缺血性心脏病所致充血性心力衰竭患者的有益作用。
