Captopril Effects on Pulmonary and Systemic Hemodynamics in Chronic Cor Pulmonale

Zieliński, J; Hawryłkiewicz, I; Górecka, Dorota; Głuskowski, J; Kościńska, M

doi:10.1378/chest.90.4.562

Cited by 32 publications

(14 citation statements)

References 26 publications

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“…This would produce a worsening of the ventilationperfusion mismatch and hence an increase in pulmonary venous oxygen desaturation. Single-dosing studies with ACE inhibitors have shown variable effects on pulmonary arterial pressure in patients with cor pulmonale [21][22][23]. However, it is probably more meaningful to investigate chronic-dosing effects of ACE inhibitors in terms of haemodynamics, gas exchange and survival [24,25].…”

Section: Discussionmentioning

confidence: 99%

Comparative effects of angiotensin II on Doppler parameters of left and right heart systolic and diastolic blood flow.

Lipworth

Dagg

1994

Brit J Clinical Pharma

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Section: Discussionmentioning

confidence: 99%

Comparative effects of angiotensin II on Doppler parameters of left and right heart systolic and diastolic blood flow.

Lipworth

Dagg

1994

Brit J Clinical Pharma

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“…Studies with ACE inhibitors in PPH have produced conflicting results in terms of pulmonary haemodynamic benefit [9,[25][26][27] and consequently these agents have not found a place in the treatment of these patients. In cor pulmonale, acute dosing studies have demonstrated variable effects on pulmonary haemodynamics [28][29][30][31][32][33] whereas chronic dosing studies have been short-term and have included only small numbers of patients [34,35] ( Table 1). The inclusion criteria for many of these studies (see Table 1) have been extremely variable with the inclusion of a heterogeneous group of subjects some of whom did not have pulmonary hypertension and were not hypoxaemic/hypercapnic.…”

Section: Therapeutic Correlatesmentioning

confidence: 99%

The role of the renin‐angiotensin and natriuretic peptide systems in the pulmonary vasculature.

Cargill

Lipworth

1995

Brit J Clinical Pharma

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1 The role of vasoactive peptide systems in the pulmonary vasculature has been studied much less extensively than systemic vascular and endocrine effects. The current understanding of the role of the renin-angiotensin (RAS) and natriuretic peptide systems (NPS) in the pulmonary ciruclation is therefore reviewed. 2 Plasma concentrations of angiotensin II, the main vasoactive component of the RAS, are elevated in pulmonary hypertension and may interact with hypoxaemia to cause further pulmonary vasoconstriction. Pharmacological manipulation of angiotensin II can attenuate hypoxic pulmonary vasoconstriction but larger studies are needed to establish the efficacy of this therapeutic strategy in established pulmonary hypertension. 3 Although all the known natriuretic peptides, ANP, BNP and CNP are elevated in cor pulmonale, only ANP and BNP appear to have pulmonary vasorelaxant activity in humans. ANP and BNP can also attenuate hypoxic pulmonary vasoconstriction, suggesting a possible counter-regulatory role for these peptides. Inhibition of ANP/BNP metabolism by neutral endopeptidase has been shown to attenuate development of hypoxic pulmonary hypertension but this property has not been tested in humans. 4 It is also well established that there are potentially important endocrine and systemic circulatory interactions between the RAS and NPS. This also occurs in the pulmonary circulation and in humans, where at least BNP acts to attenuate angiotensin II induced pulmonary vasoconstriction. This interaction may be particularly relevant as a mechanism to counter-regulate overactivity of the RAS. 5 Although the NPS and RAS have profound effects on the pulmonary circulation, the therapeutic potential of manipulating these systems has yet to be realised.

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“…The effects of captopril on pulmonary hypertension in chronic obstructive pulmonary disease (COPD) are not yet obvious. In previous works, there was no change in pulmonary hemodynamics after an injection of 50 mg of captopril [8,9] or after 25 mg [10]. Another study showed a decrease in PAP with an increase in cardiac output after 25 mg of captopril 3 times daily for 3 days, associated with low-flow oxygen therapy [11].…”

Section: Introductionmentioning

confidence: 92%

Effects of Captopril Combined with Oxygen Therapy at Rest and on Exercise in Patients with Chronic Bronchitis and Pulmonary Hypertension

Pison

Wolf²,

Lévy³

et al. 1991

Respiration

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The aim of this study was to determine the effects of captopril combined with oxygen therapy on pulmonary hemodynamics and gas exchange in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension. Eleven subjects, with severe airflow obstruction (FEV₁/FVC: 42 ± 11%) and chronic respiratory failure (PaO₂: 54 ± 6 mm Hg, PaCO₂:46 ± 8 mm Hg) treated with long-term oxygen, underwent two successive hemodynamic and arterial gas studies, at rest and during exercise. All the studies were performed whilst the patients were breathing oxygen, at rest and during exercise and 1 h after intake of 12.5 mg of captopril. The second study was performed in 9 out of the 11 patients after 8 weeks of treatment with 12.5 mg captopril 3 times daily. At rest, there was no significant effect of captopril. Mean pulmonary arterial pressure (PAP) showed a trend towards decrease after 8 weeks treatment. During exercise, there was a statistically significant decrease of mean PAP, pulmonary capillary wedge pressure and total pulmonary vascular resistance, without any deleterious effect on blood gases. However, the clinical significance of these variations during exercise is poor. We conclude that a low dose of captopril associated with oxygen therapy has no significant clinical effect on pulmonary hemodynamics at rest and during exercise in COPD

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Captopril Effects on Pulmonary and Systemic Hemodynamics in Chronic Cor Pulmonale

Cited by 32 publications

References 26 publications

Comparative effects of angiotensin II on Doppler parameters of left and right heart systolic and diastolic blood flow.

Comparative effects of angiotensin II on Doppler parameters of left and right heart systolic and diastolic blood flow.

The role of the renin‐angiotensin and natriuretic peptide systems in the pulmonary vasculature.

Effects of Captopril Combined with Oxygen Therapy at Rest and on Exercise in Patients with Chronic Bronchitis and Pulmonary Hypertension

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