Abstract | AIMS: METHODS AND RESULTS: The studied population consisted of 70 patients (mean age 59+/-9 years). Plasma renin activity and plasma concentration of aldosterone, norepinephrine, atrial natriuretic peptide, angiotensin II, tumour necrosis factor, interleukin-6 and interleukin-1B were assessed at 6 months of ACE inhibitor therapy. Mean left ventricular ejection fraction was 24+/-5% and the end-systolic and end-diastolic diameters were 59+/-9 and 71+/-8 mm, respectively. Despite chronic enalapril or captopril therapy, 35 patients (50%) had increased plasma angiotensin II (median 33 pg. ml(-1), range 17-84), while it was in the normal range in the remaining 35 patients (median 10 pg. ml(-1), range 5-15). Plasma renin activity (P=0.005), interleukin-6 (P=0.004), New York Heart Association functional class III-IV (P=0. 006), furosemide dose (P=0.01), lack of beta-blocker therapy (P=0. 04) and norepinephrine (P=0.04) were univariately associated with increased angiotensin II. Multivariate regression analysis identified the plasma renin activity (0.0004), norepinephrine (0.02) and interleukin-6 (0.03) as independent predictors of plasma angiotensin II. During follow-up (35+/-29 months), nine (12.8%) patients died and 13 had new heart failure episodes. Increased plasma angiotensin II, despite ACE inhibitor therapy, was a significant predictor of death or heart failure according to the Kaplan-Meier survival method by log rank test (P=0.002). CONCLUSION: Fifty per cent of patients with heart failure, ha increased plasma angiotension II despite chronic ACE inhibitor therapy. These patients had higher neurohormonal activation and poor prognosis.
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Authors | E Roig, F Perez-Villa, M Morales, W Jiménez, J Orús, M Heras, G Sanz |
Journal | European heart journal
(Eur Heart J)
Vol. 21
Issue 1
Pg. 53-7
(Jan 2000)
ISSN: 0195-668X [Print] England |
PMID | 10610744
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright 2000 The European Society of Cardiology. |
Chemical References |
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Angiotensin II
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Topics |
- Angiotensin II
(blood)
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Cardiomyopathy, Dilated
(blood, drug therapy)
- Heart Failure
(blood, drug therapy, mortality, physiopathology)
- Humans
- Middle Aged
- Regression Analysis
- Renin-Angiotensin System
(physiology)
- Survival Analysis
- Ventricular Dysfunction, Left
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