title: Global and regional hemodynamic effects of ramipril in congestive heart failure.
abstract: Global and regional hemodynamic changes were assessed in 11 patients with congestive heart failure following the introduction of the novel angiotensin-converting enzyme inhibitor (ACEI), ramipril. All patients were stabilized on digitalis, furosemide, and a fixed diet, central hemodynamics and hormones having been stable over 2 control days. Ramipril resulted in significant falls in converting enzyme activity, angiotensin II, and aldosterone, with a rise in renin. Changes in regional blood flow were assessed 2 h following the first dose of ramipril at the time of maximal increase in global cardiac output (+27%, p less than 0.05), but prior to the maximal fall in systemic arterial pressure. Despite the fall in systemic arterial pressure, blood flow increases were noted in the renal (+93%, p less than 0.05), coronary (+10%), and cerebral (+5%) regions, while forearm blood flow was unchanged. Glomerular filtration rate fell (29%) and was associated with small rises of plasma creatinine and acute sodium retention. After 7 weeks of therapy we noted improvement in functional class (p less than 0.05), exercise time, and left ventricular ejection fraction. We conclude that during inhibition of angiotensin-converting enzyme activity by ramipril in patients with congestive heart failure, blood flow to the kidneys, heart, and brain is increased or preserved despite hypotension. Long-term therapy is associated with beneficial clinical effects.
authors: Department of Cardiology, Princess Margaret Hospital, Christchurch, New Zealand.
authors: I G
authors: IG
authors: Crozier
authors: H
authors: H
authors: Ikram
authors: M G
authors: MG
authors: Nicholls
authors: S
authors: S
authors: Jans
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight; D001643:Bridged Bicyclo Compounds / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds / Q000627:therapeutic use*; D002302:Cardiac Output / Q000187:drug effects; D004032:Diet; D004573:Electrolytes / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects*; D006728:Hormones / Q000097:blood; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017257:Ramipril; D012039:Regional Blood Flow / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D001643:Bridged Bicyclo Compounds; D001952:Bridged-Ring Compounds; D004573:Electrolytes; D006728:Hormones; D017257:Ramipril