Enalapril and losartan augment endogenous nitric oxide release in Takayasu's arteritis--a case report.
Prognosis in Takayasu's arteritis is limited owing to renovascular hypertension. The authors report a patient with Takayasu's arteritis who had been unilaterally nephrectomized and presented with malignant hypertension due to renal artery stenosis. Hypertension was refractory to conventional antihypertensive treatment, and stenosis was not accessible by interventional angioplasty. Initiation of enalapril and losartan therapy was successful in improving blood pressure without deterioration of renal function due to ischemic failure. Antihypertensive treatment resulted in dramatically stimulated endogenous nitric oxide (NO) synthesis, while elevated plasma endothelin-1 levels were unchanged. Renovascular hypertension in Takayasu's arteritis is associated with an imbalance of vasoconstrictor peptide endothelin-1 and vasodilator peptide NO. Successful treatment of hypertension by enalapril or losartan results in improved endogenous NO synthesis, which putatively counterbalances excessive vasoconstrictor actions and may retard the progression of renal failure.
Marsen
T A
TA
Klinik IV für Innere Medizin, University of Cologne, Germany. tobias.marsen@uni-koeln.de
Sukau
G
G
Pollok
M
M
Baldamus
C A
CA
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004656:Enalapril / Q000627:therapeutic use*; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000188:drug therapy* / Q000209:etiology; D019808:Losartan / Q000627:therapeutic use*; D008875:Middle Aged; D009392:Nephrectomy; D009569:Nitric Oxide / Q000378:metabolism*; D011379:Prognosis; D012078:Renal Artery Obstruction / Q000209:etiology; D013625:Takayasu Arteritis / Q000150:complications* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000097:blood; D014665:Vasodilator Agents / Q000378:metabolism*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D019332:Endothelin-1; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D009569:Nitric Oxide; D004656:Enalapril; D019808:Losartan