The influence of posture on the response to loop diuretics in patients with chronic cardiac failure is reduced by angiotensin converting enzyme inhibition
- 24 Downloads
The diuretic and natriuretic response to an intravenous dose of frusemide 40 mg was assessed in the erect and supine positions in 10 patients with cardiac failure who were being treated with enalapril 10 mg twice daily in addition to diuretics (Enalapril group) and in 10 patients with cardiac failure taking diuretics alone (Control group).
Total 4 h diuresis in the erect position was 728 ml and in the supine position was 824 ml in the patients taking enalapril compared to 655 ml in the erect position and 1166 ml in the supine position in those patients taking diuretics alone. Total 4 h natriuresis in the erect positions was 78 mmol and in the supine position was 85 mmol in patients taking enalapril 10 mg twice daily but in those patients taking diuretics alone total 4 h natriuresis in the erect position was 67 mmol increasing to 120 mmol in the supine position.
Measurements of plasma renin activity and plasma angiotensin II concentration confirmed effective converting enzyme inhibition, in the group of patients taking enalapril, but in those patients taking diuretics alone the erect position was associated with an increase in plasma renin activity, and plasma concentrations of angiotensin II and aldsterone.
We conclude that the renin angiotensin system is a major factor in mediating the effect of posture on loop diuretic drugs.
Key wordsACE inhibitors Posture diuretics cardiac failure
Unable to display preview. Download preview PDF.
- 1.Molzahn M, Dissman TH, Halim S, Lohmann SW, Oelkers W (1972) Orthostatic changes in haemodynamics, renal function, plasma catecholamines and plasma renin concentration in normal and hypertensive man. Clin Sci 42: 209–222Google Scholar
- 2.Withering (1785) An account of the Foxglove, and some of its medical uses: with practical remarks on dropsy, and other diseases. In: Willius FA, Keys TE (eds) Cardiac classics, Kimpton, London 1941, pp 231–252Google Scholar
- 3.Ring-Larsen H, Henriksen JH, Wilken C, Clausen J, Pals H, Christensen NJ (1986) Diuretic treatment in decompensated cirrhosis and heart failure: effect of posture. Br Med J 292: 1351–1353Google Scholar
- 4.Williams GH, Cain JP, Dluhy RG, Underwood RH (1972) Studies on the control of plasma aldosterone concentration in man: respone to posture, acute and chronic volume depletion and sodium loading. J Clin Invest 51: 1731–1742Google Scholar
- 5.Seidelin PH, McMurray JJ, Struthers AD (1989) Mechanisms of the antinatriuretic action of physiological doses of angiotensin II in man. Clin Sci 76: 653–658Google Scholar
- 6.Gross GB, Imai M, Kokko J (1975) A functional comparison of the distal convoluted tubule and the cortical collecting tubule. J Clin Invest 55: 1284–1294Google Scholar
- 7.Davies RO, Irvin JD, Kramsch DK, Walker JF, Moncloa F (1984) Enalapril worldwide experience. Am J Med 77: 23–35Google Scholar
- 8.Drury PL, Edwards CRW (1981) Studies on the cryo-activation of human renin. Clin Chim Acta 113: 319–323Google Scholar
- 9.Morton JJ, Webb DJ (1985) Measurement of plasma angiotensin II. Clin Sci 68: 343–484Google Scholar
- 10.Al-Dujaili EAS, Edwards CRW (1978) The development and application of a direct radioimmunoassay for plasma aldosterone using 1125-labelled ligand: comparison of three methods. J Clin Endo and Metab 46: 105–113Google Scholar
- 11.Noskov VB (1982) Effect of body position and diuretic administration on water and mineral balance and renal activity. Hum Physiol 8: 288–291Google Scholar
- 12.Flapan AD, Davies E, Waugh C, Williams BC, Shaw TRD, Edwards CRW (1991) Acute administration of captopril lowers the natriuretic and diuretic response to a loop diuretic in patients with chronic cardiac failure. Eur Heart J 12: 924–927Google Scholar
- 13.Packer M, Lee WH, Yushak M, Medina N (1986) Comparison of captopril and enalapril in patients with severe chronic heart failure. N Engl J Med 315: 847–853Google Scholar
- 14.Kerremans AML, Van Baars H, Van Ginneken CAM, Gribnau FWJ (1983) Furosemide kinetics and dynamics in aged patients. Clin Pharmacol Ther 34: 181–189Google Scholar
- 15.Fujimara A, Ebihara A (1988) Role of angiotensin II in renal prostaglandin E2 production after furosemide administration. Hypertension 11: 491–494Google Scholar
- 16.Packer M (1987) Why do the kidneys release renin in patients with congestive heart failure? A nephrocentric view of converting enzyme inhibition. Am J Cardiol 60: 179–184Google Scholar
- 17.Francis GS, Siegel RM, Goldsmith SR, Olivari MT, Levine TB, Cohn JN (1985) Acute vasoconstrictor response to intravenous frusemide in patients with chronic congestive heart failure. Ann Intern Med 103: 1–6Google Scholar
- 18.Lohmeier TE, Cowley AW, Trippodo NC, Hall JE, Guyton AC (1977) Effects of endogenous angiotensin II on renal sodium excretion and renal haemodynamics. Am J Physiol 233: F388-F395Google Scholar
- 19.Harris PJ, Navar LG, Ploth DW (1984) Evidence for angiotensin stimulated proximal tubular fluid reabsorption in normotensive and hypertensive rats: effect of cute administration of captopril. Clin Sci 66: 541–544Google Scholar
- 20.Siragy HM, Lamb NE, Woodson JF, Ragsdale NF, Rose CE, Peach MJ, Carey RM (1987) Renal sensitivity to angiotensin II in the conscious dog. Endocrinology 120: 1272–1278Google Scholar
- 21.Dusing B, Moritz J, Glanzer K, Kramer HJ (1985) Effect of angiotensin II and captopril on renal tubular function in man. Br J Clin Pharmacol 19: 29–35Google Scholar
- 22.Burg M, Stoner L, Cardinal J, Green N (1973) Frusemide: effect on isolated perfused tubules. Am J Physiol 225: 119–124Google Scholar
- 23.Brown JJ, Davies DL, Johnson VW, Lever AF (1970) Renin relationships in congestive heart failure: treated and untreated. Am Heart J 80: 329–342Google Scholar
- 24.Creager MA, Halperin JL, Bernard DB (1981) Acute regional and circulatory response and renal haemodynamic effects of converting enzyme inhibition in patients with cardiac failure. Circulation 64: 483–489Google Scholar
- 25.Barnes JN, Drew PJT, Furniss JSS, Holly JMP, Knight AR, Skehan JD, Goodwin JF (1985) Effect of angiotensin converting enzyme inhibition on potassium mediated aldosterone secretion in essential hypertension. Clin Sci 68: 625–630Google Scholar
- 26.James VHT, Tunbridge RDG, Wilson GA (1976) Studies on the control of aldosterone secretion in man. J Steroid Biochem 7: 941–948Google Scholar
- 27.Ogihara T, Shima J, Hara H, Kumarhara Y, Kangawa K, Matsuo H (1986) Changes in human atrial natriuretic polypeptide concentration in normal subjects during passive leg raising and whole body tilting. Clin Sci 71: 148–150Google Scholar
- 28.Anderson JN, Struthers AD, Payne NN, Slater JDH, Bloom SR (1986) Atrial natriuretic peptide inhibits the aldosterone response to angiotensin II in man. Clin Sci 70: 507–512Google Scholar
- 29.Asher R (1947) The dangers of going to bed. Br Med J 2: 967–968Google Scholar