title: Candesartan and arterial baroreflex sensitivity and sympathetic nerve activity in patients with mild heart failure.
abstract: The purpose of this study was to investigate the effects of candesartan on arterial baroreflex sensitivity (BRS) and sympathetic activity in patients with mild heart failure (HF). Arterial pressure, heart rate, plasma renin activity, plasma angiotensin II and noradrenaline, and muscle sympathetic nerve activity (MSNA) were measured before therapy and after 4 weeks in 20 patients with mild HF. Patients were assigned to a candesartan group (n = 10) or a placebo group (n = 10). Baroreflex sensitivity was assessed by using phenylephrine. Candesartan induced an increase in plasma renin activity and plasma angiotensin II associated with a reduction in arterial pressure without affecting heart rate. Although plasma noradrenaline was unchanged (320 +/- 322 pg/ml to 339 +/- 104 pg/ml), MSNA decreased significantly (52 +/- 11 bursts/min to 42 +/- 9 bursts/min; p < 0.01)) and BRS increased significantly (6.9 +/- 3.6 msec/mm Hg to 10.2 +/- 3.3 msec/mm Hg; p < 0.01) after candesartan. However, there were no significant changes in the measured variables in the placebo group. These data indicate that candesartan treatment enhanced BRS and reduced sympathetic activity in patients with mild HF. Thus, the inhibitory effect of candesartan on sympathetic activity may, at least in part, contribute to the beneficial effect of angiotensin II receptor blockade in patients with mild HF.
authors.affiliation: The Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hikosaka
authors.forename: Fumio
authors.initials: F
authors.lastname: Yuasa
authors.forename: Reisuke
authors.initials: R
authors.lastname: Yuyama
authors.forename: Jun
authors.initials: J
authors.lastname: Mimura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kawamura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Motohiro
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sugiura
authors.forename: Toshiji
authors.initials: T
authors.lastname: Iwasaka
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D017704:Baroreflex / Q000187:drug effects*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D002303:Cardiac Output, Low / Q000188:drug therapy*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013564:Sympathetic Nervous System / Q000187:drug effects*; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan