Prognostic value of neurohumoral activation in patients with an acute myocardial infarction: Effect of captopril

Rouleau, Jean L.; Packer, Milton; Moyé, Lemuel A.; Champlain, Jacques de; Bichet, Daniel G.; Klein, M.; Rouleau, Jacques R.; Sussex, Bruce; Arnold, J. Malcolm O.; Sestier, F; Parker, John O.; McEwan, Patricia; Bernstein, Victoria; Cuddy, T. Edward; Lamas, Gervasio A.; Gottlieb, Stephen S.; McCans, John; Nadeau, Christine; Delage, F; Wun, Chuan-Chuan; Pfeffer, Marc A.

doi:10.1016/0735-1097(94)90001-9

Cited by 266 publications

(158 citation statements)

References 25 publications

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“…Statistical analysis of BP changes from baseline was performed using a mixed-effect model with treatment (aliskiren or irbesartan) and day (14,29,57,85) as fixed factors, and subject (nested in treatment) as a random factor. The number of patients with overall control of BP (defined as o135/85 mm Hg) was analysed using a logistic regression model with treatment as a fixed factor and baseline msSBP and msDBP as covariates.…”

Section: Discussionmentioning

confidence: 99%

“…11 Several studies have shown an association of elevated PRA with an increased risk of cardiovascular events. [12][13][14] Given the importance of RAAS overactivation in metabolic disorders, direct renin inhibition may be of particular benefit for patients with metabolic syndrome. Previous studies have shown that aliskiren-based treatment is superior to thiazide diuretic treatment for BP control in patients with hypertension and obesity.…”

Section: Introductionmentioning

confidence: 99%

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Comparative efficacy and safety of aliskiren and irbesartan in patients with hypertension and metabolic syndrome

Krone

Hanefeld

Hf³

et al. 2010

J Hum Hypertens

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Metabolic syndrome, a cluster of risk factors that increase the risk of cardiovascular morbidity and mortality, is common in patients with hypertension. Chronic renin-angiotensin-aldosterone system (RAAS) activation, shown by elevated plasma renin activity (PRA), is implicated in many of the features of metabolic syndrome. The direct renin inhibitor aliskiren may be of benefit in this patient group as aliskiren targets the RAAS at the rate-limiting step. In this double-blind study, 141 patients with hypertension (mean baseline BP 155/93 mm Hg) and metabolic syndrome (modified National Cholesterol Education Program ATP III criteria) were randomized to aliskiren 300 mg or irbesartan 300 mg once daily. Patients treated with aliskiren 300 mg had their mean sitting blood pressure (BP) lowered by 13.8/ 7.1 mm Hg after 12 weeks, significantly greater (Pp0.001) than the 5.8/2.8 mm Hg reduction observed in patients treated with irbesartan 300 mg. A significantly greater proportion of patients treated with aliskiren achieved BP control to o135/85 mm Hg (29.2 vs 16.7% with irbesartan; P ¼ 0.019). Aliskiren treatment led to a 60% decrease in PRA from baseline, whereas irbesartan increased PRA by 99% (both Po0.001). Aliskiren and irbesartan had similar effects on glucose and lipid profiles and on a panel of biomarkers of inflammation and cardiovascular risk. Both aliskiren and irbesartan were well tolerated. Collectively, these results suggest that aliskiren 300 mg may offer treatment benefits compared with irbesartan 300 mg for BP reduction in patients with hypertension and metabolic syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of aliskiren and irbesartan in patients with hypertension and metabolic syndrome

Krone

Hanefeld

Hf³

et al. 2010

J Hum Hypertens

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“…In the SAVE trial, elevated plasma renin activity predicted a moderate increase in efficacy of captopril in reducing 1-year but not total cardiovascular mortality rates. 21 Enalapril offered a greater survival benefit in those with more markedly increased NE and renin levels in the Veterans Administration Heart Failure Trial II (V-HeFT II). 4 The relation of neurohormonal status to treatment effect on rates of worsening heart failure was not addressed in the latter report.…”

Section: Discussionmentioning

confidence: 99%

Neurohumoral Prediction of Benefit From Carvedilol in Ischemic Left Ventricular Dysfunction

Richards¹,

Doughty²,

Nicholls³

et al. 1999

Circulation

196

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Background-Plasma neurohormones were analyzed for prediction of adverse outcomes and response to treatment in 415 patients with ischemic left ventricular dysfunction randomly assigned to receive carvedilol or placebo. Methods and Results-Atrial natriuretic peptide, brain natriuretic peptide (BNP), or norepinephrine (NE) levels above the group median were associated with increased mortality rates and heart failure. On multivariate analysis, both BNP and NE interacted with treatment to predict death or heart failure independent of age, New York Heart Association class, and left ventricular ejection fraction. For placebo, supramedian levels of BNP were associated with 3-fold the mortality rate of inframedian levels (20/104; 19% vs 6/99; 6%; PϽ0.01). For carvedilol, mortality rate was comparable in these 2 subgroups (12/109; 11% vs 8/94; 9%; NS). Corresponding rates for heart failure were 29/104 (28%) versus 3/99 (3%; PϽ0.001) for placebo and 16/109 (15%) versus 7/94 (7%; NS) for carvedilol. High NE levels did not predict additional benefit from carvedilol, which significantly reduced heart failure admissions only in those with NE levels below the median (13.1% to 4.0%; PϽ0.01). In the 23% of the study population with supramedian BNP but inframedian levels of NE, carvedilol reduced hospital admission with heart failure by Ͼ90% (PϽ0.001). Conclusions-Carvedilol reduced mortality rates and heart failure in those with higher pretreatment BNP levels but lesser activation of plasma NE. Neurohumoral profiling may guide introduction of ␤-blockade in heart failure. (Circulation. 1999;99:786-792.)

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“…This has been shown, for example, in patients with congestive heart failure, in which indirect and direct markers of systemic and regional sympathetic drive (venous plasma norepinephrine, heart rate variability, heart rate spectral power, cardiac and renal norepinephrine spillover) have been documented to bear a close and direct relationship with cardiovascular mortality, disease progression and arrhythmic events, including sudden death (46)(47)(48)(49)(50)(51). Similar conclusions have been drawn by assessing the prognostic values of plasma norepinephrine or heart rate variability in the post-stroke phase following an acute myocardial infarction or in patients with vasospastic angina (52)(53)(54)(55).…”

Section: Sympathetic Activation Cardiovascular Risk and Organ Damagementioning

confidence: 99%

Sympathetic Overdrive and Cardiovascular Risk in the Metabolic Syndrome

Grassı

2006

Hypertens Res

121

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Prognostic value of neurohumoral activation in patients with an acute myocardial infarction: Effect of captopril

Cited by 266 publications

References 25 publications

Comparative efficacy and safety of aliskiren and irbesartan in patients with hypertension and metabolic syndrome

Comparative efficacy and safety of aliskiren and irbesartan in patients with hypertension and metabolic syndrome

Neurohumoral Prediction of Benefit From Carvedilol in Ischemic Left Ventricular Dysfunction

Sympathetic Overdrive and Cardiovascular Risk in the Metabolic Syndrome

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