Influence of ACE inhibition on fluid metabolism in chronic heart failure and its pathophysiologic relevance

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Abstract

Background: In congestive heart failure with water retention. subtraction of body fluid by ultrafiltration causes greater diuresis and clinical improvement in patients who are angiotensin-converting enzyme (ACE)-inhibited. suggesting an influence of ACE inhibitors on fluid metabolism. Methods and Results: Patients with moderate congestive heart failure were subjected to ultrafiltration (around 2000 mL) and followed up for 3 months. Usual outpatient therapy, consisting of digoxin, furosemide. and ACE inhibitors (18 patients, group A) and of digoxin and furosemide only (18 patients, group B), was continued throughout the trial. Hemodynamics, renal function, body fluid and electrolytes. plasma norepinephrine, renin activity, aldosterone. and plasma volume were monitored. At 30 and 90 days after ultnfiltration. hormones, renal function, functional capacity (based on cardiopulmonary tests), and extravascular lung water (chest radiograph score) were determined. Soon after ultrafiltration. body weight. plasma volume, and diuresis were reduced (hypovolemia) and hormones were raised (reaction to hypovolemia). In the next 4 days. all these variables reverted to the pre-ultrafiltration values in group B; in group A diuresis and plasma volume recovered, body weight was still reduced, and hormones became lower than baseline. These changes persisted in the next 3 months. An early reduction of extravascular lung water continued long term in group A only, associated with increase of exercise tolerance time and oxygen uptake and decrease of the dead space/tidal volume ratio. Conclusions: In congestive heart failure. ACE inhibition persistently prevented fluid accumulation once the excess of body fluid had been withdrawn with a nonpharmacologic method, resulting in sustained improvement in functional capacity. Reduction in circulating norepinephrine, aldosterone. and renin did not seem to be the cause but the consequence of this action, whose mechanisms remain undefined.

Original languageEnglish
Pages (from-to)279-286
Number of pages8
JournalJournal of Cardiovascular Pharmacology and Therapeutics
Volume1
Issue number4
DOIs
Publication statusPublished - 1996

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Ultrafiltration
Peptidyl-Dipeptidase A
Plasma Volume
Diuresis
Body Fluids
Heart Failure
Extravascular Lung Water
Hypovolemia
Digoxin
Furosemide
Hormones
Aldosterone
Angiotensin-Converting Enzyme Inhibitors
Renin
Norepinephrine
Body Weight
Kidney
Exercise Tolerance
Tidal Volume
Electrolytes

Keywords

  • Fluid metabolism
  • Functional capacity
  • Lung water

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

@article{1412db20c7334ef2b6dabfba8f3fdf8b,
title = "Influence of ACE inhibition on fluid metabolism in chronic heart failure and its pathophysiologic relevance",
abstract = "Background: In congestive heart failure with water retention. subtraction of body fluid by ultrafiltration causes greater diuresis and clinical improvement in patients who are angiotensin-converting enzyme (ACE)-inhibited. suggesting an influence of ACE inhibitors on fluid metabolism. Methods and Results: Patients with moderate congestive heart failure were subjected to ultrafiltration (around 2000 mL) and followed up for 3 months. Usual outpatient therapy, consisting of digoxin, furosemide. and ACE inhibitors (18 patients, group A) and of digoxin and furosemide only (18 patients, group B), was continued throughout the trial. Hemodynamics, renal function, body fluid and electrolytes. plasma norepinephrine, renin activity, aldosterone. and plasma volume were monitored. At 30 and 90 days after ultnfiltration. hormones, renal function, functional capacity (based on cardiopulmonary tests), and extravascular lung water (chest radiograph score) were determined. Soon after ultrafiltration. body weight. plasma volume, and diuresis were reduced (hypovolemia) and hormones were raised (reaction to hypovolemia). In the next 4 days. all these variables reverted to the pre-ultrafiltration values in group B; in group A diuresis and plasma volume recovered, body weight was still reduced, and hormones became lower than baseline. These changes persisted in the next 3 months. An early reduction of extravascular lung water continued long term in group A only, associated with increase of exercise tolerance time and oxygen uptake and decrease of the dead space/tidal volume ratio. Conclusions: In congestive heart failure. ACE inhibition persistently prevented fluid accumulation once the excess of body fluid had been withdrawn with a nonpharmacologic method, resulting in sustained improvement in functional capacity. Reduction in circulating norepinephrine, aldosterone. and renin did not seem to be the cause but the consequence of this action, whose mechanisms remain undefined.",
keywords = "Fluid metabolism, Functional capacity, Lung water",
author = "Piergiuseppe Agostoni and Giancarlo Marenzi and Marco Guazzi and Guazzi, {Maurizio D.}",
year = "1996",
doi = "10.1177/107424849600100403",
language = "English",
volume = "1",
pages = "279--286",
journal = "Journal of Cardiovascular Pharmacology and Therapeutics",
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TY - JOUR

T1 - Influence of ACE inhibition on fluid metabolism in chronic heart failure and its pathophysiologic relevance

AU - Agostoni, Piergiuseppe

AU - Marenzi, Giancarlo

AU - Guazzi, Marco

AU - Guazzi, Maurizio D.

PY - 1996

Y1 - 1996

N2 - Background: In congestive heart failure with water retention. subtraction of body fluid by ultrafiltration causes greater diuresis and clinical improvement in patients who are angiotensin-converting enzyme (ACE)-inhibited. suggesting an influence of ACE inhibitors on fluid metabolism. Methods and Results: Patients with moderate congestive heart failure were subjected to ultrafiltration (around 2000 mL) and followed up for 3 months. Usual outpatient therapy, consisting of digoxin, furosemide. and ACE inhibitors (18 patients, group A) and of digoxin and furosemide only (18 patients, group B), was continued throughout the trial. Hemodynamics, renal function, body fluid and electrolytes. plasma norepinephrine, renin activity, aldosterone. and plasma volume were monitored. At 30 and 90 days after ultnfiltration. hormones, renal function, functional capacity (based on cardiopulmonary tests), and extravascular lung water (chest radiograph score) were determined. Soon after ultrafiltration. body weight. plasma volume, and diuresis were reduced (hypovolemia) and hormones were raised (reaction to hypovolemia). In the next 4 days. all these variables reverted to the pre-ultrafiltration values in group B; in group A diuresis and plasma volume recovered, body weight was still reduced, and hormones became lower than baseline. These changes persisted in the next 3 months. An early reduction of extravascular lung water continued long term in group A only, associated with increase of exercise tolerance time and oxygen uptake and decrease of the dead space/tidal volume ratio. Conclusions: In congestive heart failure. ACE inhibition persistently prevented fluid accumulation once the excess of body fluid had been withdrawn with a nonpharmacologic method, resulting in sustained improvement in functional capacity. Reduction in circulating norepinephrine, aldosterone. and renin did not seem to be the cause but the consequence of this action, whose mechanisms remain undefined.

AB - Background: In congestive heart failure with water retention. subtraction of body fluid by ultrafiltration causes greater diuresis and clinical improvement in patients who are angiotensin-converting enzyme (ACE)-inhibited. suggesting an influence of ACE inhibitors on fluid metabolism. Methods and Results: Patients with moderate congestive heart failure were subjected to ultrafiltration (around 2000 mL) and followed up for 3 months. Usual outpatient therapy, consisting of digoxin, furosemide. and ACE inhibitors (18 patients, group A) and of digoxin and furosemide only (18 patients, group B), was continued throughout the trial. Hemodynamics, renal function, body fluid and electrolytes. plasma norepinephrine, renin activity, aldosterone. and plasma volume were monitored. At 30 and 90 days after ultnfiltration. hormones, renal function, functional capacity (based on cardiopulmonary tests), and extravascular lung water (chest radiograph score) were determined. Soon after ultrafiltration. body weight. plasma volume, and diuresis were reduced (hypovolemia) and hormones were raised (reaction to hypovolemia). In the next 4 days. all these variables reverted to the pre-ultrafiltration values in group B; in group A diuresis and plasma volume recovered, body weight was still reduced, and hormones became lower than baseline. These changes persisted in the next 3 months. An early reduction of extravascular lung water continued long term in group A only, associated with increase of exercise tolerance time and oxygen uptake and decrease of the dead space/tidal volume ratio. Conclusions: In congestive heart failure. ACE inhibition persistently prevented fluid accumulation once the excess of body fluid had been withdrawn with a nonpharmacologic method, resulting in sustained improvement in functional capacity. Reduction in circulating norepinephrine, aldosterone. and renin did not seem to be the cause but the consequence of this action, whose mechanisms remain undefined.

KW - Fluid metabolism

KW - Functional capacity

KW - Lung water

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