Comparative hemodynamic effects of converting enzyme inhibitor and sodium nitroprusside in severe heart failure

Thomas R. Vrobel, Jay N Cohn

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

In nine patients with severe congestive heart failure, the acute response to the infusion of a nonspecific vasodilator, sodium nitroprusside, was compared with the infusion of the converting enzyme inhibitor, teprotide (SQ 20, 881). The hemodynamic effects were similar. Nitroprusside and teprotide increased cardiac index 24 and 20 percent, respectively, reduced mean arterial pressure 11 and 14 percent and pulmonary wedge pressure 21 and 24 percent, and produced no significant change in heart rate (-0.5 and -0.7 percent). Arterial partial pressure of oxygen decreased in response to nitroprusside infusion from 75.8 ± 4.1 to 65.4 ± 3.2 mm Hg (p < 0.05) but did not change in response to teprotide infusion (77.0 ± 4.5 before and 76.3 ± 3.0 mm Hg after). Circulating norepinephrine levels were lowered in response to both agents in spite of the decrease in mean arterial pressure (nitroprusside 754 ± 126 to 580 ± 82 pg/ml, p < 0.05; teprotide 807 ± 136 to 518 ± 92 pg/ml, p < 0.05). Although the control plasma renin activity did not correlate closely with the hemodynamic response to either agent in this small series, this level did correlate directly with the dose of nitroprusside required to produce the desired hemodynamic response. Therefore, converting enzyme inhibition produces an acute hemodynamic response in severe congestive heart failure comparable with that of sodium nitroprusside with less detrimental acute effect on pulmonary oxygen transport. Long-term oral therapy with converting enzyme inhibitor deserves evaluation in congestive heart failure.

Original languageEnglish (US)
Pages (from-to)331-336
Number of pages6
JournalThe American Journal of Cardiology
Volume45
Issue number2
DOIs
StatePublished - Feb 1980

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Teprotide
Nitroprusside
Enzyme Inhibitors
Heart Failure
Hemodynamics
Arterial Pressure
Oxygen
Pulmonary Wedge Pressure
Partial Pressure
Vasodilator Agents
Renin
Norepinephrine
Heart Rate
Lung
Enzymes

Cite this

Comparative hemodynamic effects of converting enzyme inhibitor and sodium nitroprusside in severe heart failure. / Vrobel, Thomas R.; Cohn, Jay N.

In: The American Journal of Cardiology, Vol. 45, No. 2, 02.1980, p. 331-336.

Research output: Contribution to journalArticle

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