title: Comparative effects of angiotensin receptor blockade and ACE inhibition on the fibrinolytic and inflammatory responses to cardiopulmonary bypass.
abstract: The effects of angiotensin-converting enzyme (ACE) inhibition and angiotensin II type 1 receptor blockade (ARB) on fibrinolysis and inflammation after cardiopulmonary bypass (CPB) are uncertain. This study tested the hypothesis that ACE inhibition enhances fibrinolysis and inflammation to a greater extent than ARB in patients undergoing CPB. One week to 5 days before surgery, patients were randomized to ramipril 5 mg/day, candesartan 16 mg/day, or placebo. ACE inhibition increased intraoperative bradykinin and tissue-type plasminogen activator (t-PA ) concentrations as compared to AR B. Both ACE inhibition and AR B decreased the need for plasma transfusion relative to placebo, but only ACE inhibition decreased the duration of hospital stay. Neither ACE inhibition nor AR B significantly affected concentrations of plasminogen activator inhibitor-1 (PAI -1), interleukin (IL )-6, IL -8, or IL -10. ACE inhibition enhanced intraoperative fibrinolysis without increasing the likelihood of red-cell transfusion. By contrast, neither ACE inhibition nor ARB affected the inflammatory response. ACE inhibitors and ARBs may be safely continued until the day of surgery.
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical School, Nashville, Tennessee, USA.
authors.forename: F T
authors.initials: FT
authors.lastname: Billings
authors.forename: J M
authors.initials: JM
authors.lastname: Balaguer
authors.forename: Yu
authors.initials: Y
authors.lastname: C
authors.forename: P
authors.initials: P
authors.lastname: Wright
authors.forename: M R
authors.initials: MR
authors.lastname: Petracek
authors.forename: J G
authors.initials: JG
authors.lastname: Byrne
authors.forename: N J
authors.initials: NJ
authors.lastname: Brown
authors.forename: M
authors.initials: M
authors.lastname: Pretorius
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001803:Blood Transfusion; D001920:Bradykinin / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D023381:Endpoint Determination; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006400:Hematocrit; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology; D007378:Interleukins / Q000378:metabolism; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D017257:Ramipril / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D007378:Interleukins; D013777:Tetrazoles; D017257:Ramipril; C081643:candesartan; D001920:Bradykinin