The circulating renin–angiotensin system during treatment with metoprolol or captopril in patients with heart failure due to non‐ischaemic dilated cardiomyopathy

Abstract

). The circulating renin]angiotensin system during treatment with metoprolol or captopril in patients with heart failure due to non-ischaemic dilated cardiomyopathy. J Intern Med 1999; 245: 435]443.Objective. To investigate the effects of beta-blocker (metoprolol) or angiotensin-converting enzyme inhibitor (captopril) treatment on neurohormonal function in a randomized prospective study on patients with heart failure due to dilated cardiomyopathy. Patients. Fifty-four patients (42 men and 12 women, mean age 50 years) were studied. There were three patients in NYHA (New York Heart Association) functional class I, 32 patients in class II and 19 patients in class III. Methods. Measurements of plasma renin activity (PRA), plasma angiotensin II (A II) concentration and plasma atrial natriuretic peptide (ANP) concentration were made at rest and also in a subgroup (n = 32) during exercise. The urinary excretion of aldosterone was also determined. Investigations were performed at baseline, and after 3 and 6 months. Therapy was then stopped and the patients were re-investigated 1 month thereafter. Results. The mean level of PRA was normal at baseline, reduced during therapy with metoprolol, and increased during therapy with captopril. The mean plasma concentration of A II was reduced during exercise and there was a trend towards a reduction even at rest in the metoprolol group, but not in the captopril group. The urinary excretion of aldosterone decreased in both groups. The mean plasma concentration of ANP was elevated at baseline and declined during exercise in the metoprolol group. Conclusion. In patients with dilated cardiomyopathy and only a partly activated renin]angiotensin system, both metoprolol and captopril reduced urinary excretion of aldosterone. Furthermore, metoprolol suppressed the exercise-induced increase in ANP, suggesting a favourable effect on ventricular performance.

Importance of the renin–angiotensin system in the regulation of arterial blood pressure in conscious mice and rats

“…Interestingly, the plasma ANG II obtained from captopril‐infused C57 mice and SD rats was not significantly different from those of control animals. This observation is not totally unexpected, however, as previous studies in both humans (Jansson et al. 1999) and rats (Riegger et al.…”

NT‐proBNP in severe chronic heart failure: rationale, design and preliminary results of the COPERNICUS NT‐proBNP substudy

“…Conflicting findings have been reported regarding the influence of beta‐blocker therapy on natriuretic peptide levels. In a study by Jansson et al, metoprolol suppressed the exercise‐induced increase of ANP in patients with dilated cardiomyopathy, suggesting a favourable effect on ventricular performance [28]. Kawai et al reported that chronic beta‐blocker therapy decreased circulating brain natriuretic peptide concentrations, interpreted as an indicator of response to treatment [29].…”

Arrhythmias after COVID-19 Vaccination: Have We Left All Stones Unturned?

“…The spike protein—whether from COVID or vaccine—could represent the key to understanding the molecular pathway of the heart conduction abnormality. Binding with high affinity to ACE2 could potentially result in an ACE imbalance, thus promoting cardiac complications [ 85 , 86 ]. Heart rhythm conduction is highly affected by ACEs, and its alteration may promote heart rhythm disorders ( Figure 1 ).…”

“…Cardiac arrhythmias have a high mortality and morbidity and need further investigation. Metoprolol has a beneficial effect on the AT II pathway [ 85 , 86 ], and its use as a treatment was very effective.…”