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Schaich CL, Leisman DE, Goldberg MB, Filbin MR, Khanna AK, Chappell MC. Dysfunction of the renin-angiotensin-aldosterone system in human septic shock. Peptides 2024; 176:171201. [PMID: 38555976 PMCID: PMC11060897 DOI: 10.1016/j.peptides.2024.171201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
Sepsis and septic shock are global healthcare problems associated with mortality rates of up to 40% despite optimal standard-of-care therapy and constitute the primary cause of death in intensive care units worldwide. Circulating biomarkers of septic shock severity may represent a clinically relevant approach to individualize those patients at risk for worse outcomes early in the course of the disease, which may facilitate early and more precise interventions to improve the clinical course. However, currently used septic shock biomarkers, including lactate, may be non-specific and have variable impact on prognosis and/or disease management. Activation of the renin-angiotensin-aldosterone system (RAAS) is likely an early event in septic shock, and studies suggest that an elevated level of renin, the early and committed step in the RAAS cascade, is a better predictor of worse outcomes in septic shock, including mortality, than the current standard-of-care measure of lactate. Despite a robust increase in renin, other elements of the RAAS, including endogenous levels of Ang II, may fail to sufficiently increase to maintain blood pressure, tissue perfusion, and protective immune responses in septic shock patients. We review the current clinical literature regarding the dysfunction of the RAAS in septic shock and potential therapeutic approaches to improve clinical outcomes.
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Affiliation(s)
- Christopher L Schaich
- Hypertension & Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Daniel E Leisman
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marcia B Goldberg
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Micheal R Filbin
- Department of Emergency Medicine, Massachusetts General Hospital,Boston, MA, USA
| | - Ashish K Khanna
- Hypertension & Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Anesthesiology, Section on Critical Care Medicine, Atrium Health Wake Forest Baptist Medical Center, USA; Outcomes Research Consortium, Cleveland, OH, USA
| | - Mark C Chappell
- Hypertension & Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Smith D, Layton A. The intrarenal renin-angiotensin system in hypertension: insights from mathematical modelling. J Math Biol 2023; 86:58. [PMID: 36952058 DOI: 10.1007/s00285-023-01891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/14/2023] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
The renin-angiotensin system (RAS) plays a pivotal role in the maintenance of volume homeostasis and blood pressure. In addition to the well-studied systemic RAS, local RAS have been documented in various tissues, including the kidney. Given the role of the intrarenal RAS in the pathogenesis of hypertension, a role established via various pharmacologic and genetic studies, substantial efforts have been made to unravel the processes that govern intrarenal RAS activity. In particular, several mechanisms have been proposed to explain the rise in intrarenal angiotensin II (Ang II) that accompanies Ang II infusion, including increased angiotensin type 1 receptor (AT1R)-mediated uptake of Ang II and enhanced intrarenal Ang II production. However, experimentally isolating their contribution to the intrarenal accumulation of Ang II in Ang II-induced hypertension is challenging, given that they are fundamentally connected. Computational modelling is advantageous because the feedback underlying each mechanism can be removed and the effect on intrarenal Ang II can be studied. In this work, the mechanisms governing the intrarenal accumulation of Ang II during Ang II infusion experiments are delineated and the role of the intrarenal RAS in Ang II-induced hypertension is studied. To accomplish this, a compartmental ODE model of the systemic and intrarenal RAS is developed and Ang II infusion experiments are simulated. Simulations indicate that AT1R-mediated uptake of Ang II is the primary mechanism by which Ang II accumulates in the kidney during Ang II infusion. Enhanced local Ang II production is unnecessary. The results demonstrate the role of the intrarenal RAS in the pathogenesis of Ang II-induced hypertension and consequently, clinical hypertension associated with an overactive RAS.
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Affiliation(s)
- Delaney Smith
- Department of Applied Mathematics, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada.
| | - Anita Layton
- Department of Applied Mathematics, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
- Cheriton School of Computer Science, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
- Department of Biology, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
- School of Pharmacy, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
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Bruno RR, Wolff G, Kelm M, Jung C. Pharmacological treatment of cardiogenic shock - A state of the art review. Pharmacol Ther 2022; 240:108230. [PMID: 35697151 DOI: 10.1016/j.pharmthera.2022.108230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
Cardiogenic shock is a clinical syndrome of impaired tissue perfusion caused by primary cardiac dysfunction and inadequate cardiac output. It represents one of the most lethal clinical conditions in intensive care medicine with mortality >40%. Management of different clinical presentations of cardiogenic shock includes guidance of cardiac preload, afterload, heart rate and contractility by differential pharmacological modulation of volume, systemic and pulmonary vascular resistance and cardiac output besides reversing the triggering cause. Data from large registries and randomized controlled trials on optimal diagnostic guidance as well as choice of pharmacological agents has accrued significantly in recent years. This state-of-the-art review summarizes the basic concepts of cardiogenic shock, the diagnostic work-up and currently available evidence and guideline recommendations on pharmacological treatment of cardiogenic shock.
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Affiliation(s)
- Raphael Romano Bruno
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Georg Wolff
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Malte Kelm
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany; Cardiovascular Research Institute Düsseldorf (CARID), Duesseldorf, Germany
| | - Christian Jung
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany.
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Jung H, Lee G, Lim K, Shin S. Association of milk consumption with management and incidence of hypertension among South Korean adults: A prospective analysis of the health examinees study cohort. Nutr Metab Cardiovasc Dis 2022; 32:2515-2525. [PMID: 36175315 DOI: 10.1016/j.numecd.2022.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND AIMS Studies have revealed a positive relationship between milk consumption and hypertension. However, few researchers have investigated the association between milk consumption and changes in blood pressure (BP) in South Korean adults. Therefore, we examined the association between milk intake and the management and risk of hypertension in South Korean adults. METHODS AND RESULTS Participants were selected from the Health Examinees study. The definition of hypertension was based on the guidelines of the Korean Society of Hypertension. The participants were divided into three groups according to changes between baseline and follow-up BP data. Milk consumption was assessed using food frequency questionnaires. In both men and women, the higher milk consumption group had increased odds of trends of BP improvement (OR: 1.249, 95% CI: 1.043-1.496, p for trend: 0.2271 in men; OR: 1.147, 95% CI: 1.014-1.297, p for trend: 0.0293 in women) and decreased odds of trends of worsening (OR: 0.861, 95% CI: 0.756-0.980, p for trend: <0.0001 in men, OR: 0.866, 95% CI: 0.794-0.943, p for trend: 0.0010 in women) compared to those of the non-consumption group. In the prospective study, milk intake was inversely associated with hypertension risk (HR: 0.900, 95% CI: 0.811-0.999, p for trend: 0.0076 in men; HR: 0.879, 95% CI: 0.814-0.949, p for trend: 0.0002 in women). CONCLUSION Increased intake of milk was inversely related to the risk of increased BP, with a decreased risk of hypertension events.
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Affiliation(s)
- Hyein Jung
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do 17546, South Korea
| | - Geongu Lee
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do 17546, South Korea
| | - Kyungjoon Lim
- Faculty of Medicine and Health, School of Medical Science, University of Sydney, NSW 2006, Australia
| | - Sangah Shin
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do 17546, South Korea.
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Louvet L, Lenglet G, Krautzberger AM, Mentaverri R, Hague F, Kowalewski C, Mahtal N, Lesieur J, Bonnet A, Andrique C, Gaucher C, Gomila C, Schrewe H, Tharaux P, Kamel S, Chaussain C, Six I. Vasorin plays a critical role in vascular smooth muscle cells and arterial functions. J Cell Physiol 2022; 237:3845-3859. [PMID: 35892191 PMCID: PMC9796581 DOI: 10.1002/jcp.30838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 01/01/2023]
Abstract
Within the cardiovascular system, the protein vasorin (Vasn) is predominantly expressed by vascular smooth muscle cells (VSMCs) in the coronary arteries and the aorta. Vasn knockout (Vasn-/- ) mice die within 3 weeks of birth. In the present study, we investigated the role of vascular Vasn expression on vascular function. We used inducible Vasn knockout mice (VasnCRE-ERT KO and VasnSMMHC-CRE-ERT2 KO , in which respectively all cells or SMCs only are targeted) to analyze the consequences of total or selective Vasn loss on vascular function. Furthermore, in vivo effects were investigated in vitro using human VSMCs. The death of VasnCRE-ERT KO mice 21 days after tamoxifen injection was concomitant with decreases in blood pressure, angiotensin II levels, and vessel contractibility to phenylephrine. The VasnSMMHC-CRE-ERT2 KO mice displayed concomitant changes in vessel contractibility in response to phenylephrine and angiotensin II levels. In vitro, VASN deficiency was associated with a shift toward the SMC contractile phenotype, an increase in basal intracellular Ca2+ levels, and a decrease in the SMCs' ability to generate a calcium signal in response to carbachol or phenylephrine. Additionally, impaired endothelium-dependent relaxation (due to changes in nitric oxide signaling) was observed in all Vasn knockout mice models. Our present findings highlight the role played by Vasn SMC expression in the maintenance of vascular functions. The mechanistic experiments suggested that these effects are mediated by SMC phenotype switching and changes in intracellular calcium homeostasis, angiotensin II levels, and NO signaling.
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Affiliation(s)
- Loïc Louvet
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV)Picardie Jules Verne UniversityAmiensFrance
| | - Gaëlle Lenglet
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV)Picardie Jules Verne UniversityAmiensFrance
| | | | - Romuald Mentaverri
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV)Picardie Jules Verne UniversityAmiensFrance,Amiens University HospitalHuman Biology CenterAmiensFrance
| | - Frédéric Hague
- UR EA4667, UPJV, Laboratoire de Physiologie Cellulaire et MoléculairePicardie Jules Verne UniversityAmiensFrance
| | - Clara Kowalewski
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV)Picardie Jules Verne UniversityAmiensFrance
| | - Nassim Mahtal
- Université Paris Cité, Paris Cardiovascular CenterINSERMParisFrance
| | - Julie Lesieur
- Université Paris Cité, URP2496F‐92120MontrougeFrance
| | - Anne‐Laure Bonnet
- Université Paris Cité, URP2496F‐92120MontrougeFrance,AP‐HP, FHU DDS‐net, Services de médecine bucco‐dentaire (GH Sorbonne Université, GH Paris Nord Université de Paris, GH Henri Mondor)ParisFrance
| | | | - Céline Gaucher
- Université Paris Cité, URP2496F‐92120MontrougeFrance,AP‐HP, FHU DDS‐net, Services de médecine bucco‐dentaire (GH Sorbonne Université, GH Paris Nord Université de Paris, GH Henri Mondor)ParisFrance
| | - Cathy Gomila
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV)Picardie Jules Verne UniversityAmiensFrance
| | - Heinrich Schrewe
- Department of Developmental GeneticsMax Planck Institute for Molecular GeneticsBerlinGermany
| | | | - Said Kamel
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV)Picardie Jules Verne UniversityAmiensFrance,Amiens University HospitalHuman Biology CenterAmiensFrance
| | - Catherine Chaussain
- Université Paris Cité, URP2496F‐92120MontrougeFrance,AP‐HP, FHU DDS‐net, Services de médecine bucco‐dentaire (GH Sorbonne Université, GH Paris Nord Université de Paris, GH Henri Mondor)ParisFrance
| | - Isabelle Six
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV)Picardie Jules Verne UniversityAmiensFrance
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Brain angiotensin converting enzyme-2 in central cardiovascular regulation. Clin Sci (Lond) 2021; 134:2535-2547. [PMID: 33016313 DOI: 10.1042/cs20200483] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
The brain renin-angiotensin system (RAS) plays an important role in the regulation of autonomic and neuroendocrine functions, and maintains cardiovascular homeostasis. Ang-II is the major effector molecule of RAS and exerts most of its physiological functions, including blood pressure (BP) regulation, via activation of AT1 receptors. Dysregulation of brain RAS in the central nervous system results in increased Ang-II synthesis that leads to sympathetic outflow and hypertension. Brain angiotensin (Ang) converting enzyme-2 (ACE2) was discovered two decades ago as an RAS component, exhibiting a counter-regulatory role and opposing the adverse cardiovascular effects produced by Ang-II. Studies using synthetic compounds that can sustain the elevation of ACE2 activity or genetically overexpressed ACE2 in specific brain regions found various beneficial effects on cardiovascular function. More recently, ACE2 has been shown to play critical roles in neuro-inflammation, gut dysbiosis and the regulation of stress and anxiety-like behaviors. In the present review, we aim to highlight the anatomical locations and functional implication of brain ACE2 related to its BP regulation via modulation of the sympathetic nervous system and discuss the recent developments and future directions in the ACE2-mediated central cardiovascular regulation.
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7
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Chen C, Kassan A, Castañeda D, Gabani M, Choi SK, Kassan M. Metformin prevents vascular damage in hypertension through the AMPK/ER stress pathway. Hypertens Res 2019; 42:960-969. [PMID: 30664704 DOI: 10.1038/s41440-019-0212-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/23/2018] [Accepted: 12/20/2018] [Indexed: 11/09/2022]
Abstract
Metformin is an antidiabetic drug. However, the pleiotropic beneficial effects of metformin in nondiabetic models still need to be defined. The objective of this study is to investigate the effect of metformin on angiotensin II (Ang II)-induced hypertension and cardiovascular diseases. Mice were infused with Ang II (400 ng/kg per min) with or without metformin for 2 weeks. Mice infused with angiotensin II displayed an increase in blood pressure associated with enhanced vascular endoplasmic reticulum (ER) stress markers, which were blunted after metformin treatment. Moreover, hypertension-induced reduction in phosphorylated AMPK, endothelial nitric oxide synthase (eNOs) phosphorylation, and endothelium-dependent relaxation (EDR) in mesenteric resistance arteries (MRA) were rescued after metformin treatment. Infusion of ER stress inducer (tunicamycin, Tun) in control mice induced ER stress in MRA and reduced phosphorylation of AMPK, eNOS synthase phosphorylation, and EDR in MRA without affecting systolic blood pressure (SBP). All these factors were reversed subsequently with metformin treatment. ER stress inhibition by metformin improves vascular function in hypertension. Therefore, metformin could be a potential therapy for cardiovascular diseases in hypertension independent of its effects on diabetes.
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Affiliation(s)
- Cheng Chen
- Department of Emergency and Critical Care, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Adam Kassan
- West Coast University, School of Pharmacy, Los Angeles, CA, 90004, USA
| | - Diana Castañeda
- California State University, Los Angeles, Los Angeles, CA, 90032, USA
| | - Mohanad Gabani
- Cardiovascular Division, Department of Medicine, and Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, IA City, IA, 52242, USA
| | - Soo-Kyoung Choi
- Department of Physiology, College of Medicine, Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, 03722, Korea
| | - Modar Kassan
- Cardiovascular Division, Department of Medicine, and Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, IA City, IA, 52242, USA.
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Protective effect of Xin-Ji-Er-Kang on cardiovascular remodeling in high salt-induced hypertensive mice. Exp Ther Med 2018; 17:1551-1562. [PMID: 30783421 PMCID: PMC6364186 DOI: 10.3892/etm.2018.7105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 11/14/2018] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to investigate the effects of Xin-Ji-Er-Kang (XJEK) on high salt-induced hypertensive mice. Mice with high-salt diet-induced hypertension were divided into four groups: Control (standard diet alone for 8 weeks), model (diet containing 8% NaCl for 8 weeks and intragastric administration of distilled water for the last 4 weeks), XJEK + high-salt-treated (diet containing 8% NaCl for 8 weeks and intragastric administration of XJEK for the last 4 weeks) and irbesartan + high-salt-treated (diet containing 8% NaCl for 8 weeks with intragastric administration of irbesartan for the last 4 weeks). The hemodynamic index and cardiac pathological changes in the hypertensive mice were then examined. An aortic ring apparatus was used to detect acetylcholine-dependent endothelium relaxation function. Colorimetric analysis was applied to determine serum nitric oxide (NO), superoxide dismutase activity and malondialdehyde content; ELISA was employed to measure brain natriuretic peptide, serum angiotensin II (Ang II), endothelin-1 content and aldosterone; and immunohistochemistry was used to detect the expression of endothelial nitric oxide synthase (eNOS), interleukin (IL)-1β, IL-10 and tumor necrosis factor (TNF)-α in cardiac tissues. XJEK improved the heart systolic and diastolic function, ameliorated hemodynamic parameters and cardiovascular remodeling indices, blunted the cardiac pathological changes and improved endothelial dysfunction (ED) via boosting eNOS activity, promoting NO bioavailability and decreasing serum Ang II content. Furthermore, treatment with XJEK inhibited the increase of IL-1β and TNF-α expression and the decrease of IL-10 expression in cardiac tissues, and ameliorated oxidative stress status. Therefore, XJEK exerted protective effects against high salt-induced hypertension and cardiovascular remodeling in mice via improving ED, restoring pro- and anti-inflammatory factor balance and decreasing oxidative stress.
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Busse LW, McCurdy MT, Ali O, Hall A, Chen H, Ostermann M. The effect of angiotensin II on blood pressure in patients with circulatory shock: a structured review of the literature. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:324. [PMID: 29282149 PMCID: PMC5745607 DOI: 10.1186/s13054-017-1896-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Circulatory shock is a common syndrome with a high mortality and limited therapeutic options. Despite its discovery and use in clinical and experimental settings more than a half-century ago, angiotensin II (Ang II) has only been recently evaluated as a vasopressor in distributive shock. We examined existing literature for associations between Ang II and the resolution of circulatory shock. METHODS We searched PubMed, MEDLINE, Ovid, and Embase to identify all English literature accounts of intravenous Ang II in humans for the treatment of shock (systolic blood pressure [SBP] ≤ 90 mmHg or a mean arterial pressure [MAP] ≤ 65 mmHg), and hand-searched the references of extracted papers for further studies meeting inclusion criteria. Of 3743 articles identified, 24 studies including 353 patients met inclusion criteria. Complete data existed for 276 patients. Extracted data included study type, publication year, demographics, type of shock, dosing of Ang II or other vasoactive medications, and changes in BP, lactate, and urine output. BP effects were grouped according to type of shock, with additional analyses completed for patients with absent blood pressure. Shock was distributive (n = 225), cardiogenic (n = 38), or from other causes (n = 90). Blood pressure as absent in 18 patients. RESULTS For the 276 patients with complete data, MAP rose by 23.4% from 63.3 mmHg to 78.1 mmHg in response to Ang II (dose range: 15 ng/kg/min to 60 mcg/min). SBP rose by 125.2% from 56.9 mmHg to 128.2 mmHg (dose range: 0.2 mcg/min to a 1500 mcg bolus). A total of 271 patients with complete data were determined to exhibit a BP effect which was directly associated with Ang II. Subgroups (patients with cardiogenic, septic, and other types of shock) exhibited similar increases in BP. In patients with absent BP, deemed to be cardiac arrest, return of spontaneous circulation (ROSC) was achieved, and BP increased by an average of 107.3 mmHg in 11 of 18 patients. The remaining seven patients with cardiac arrest did not respond. CONCLUSIONS Intravenous Ang II is associated with increased BP in patients with cardiogenic, distributive, and unclassified shock. A role may exist for Ang II in restoring circulation in cardiac arrest.
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Affiliation(s)
- Laurence W Busse
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Emory University, Emory St. Joseph's Hospital, 5665 Peachtree Dunwoody Road, Atlanta, GA, 30342, USA.
| | - Michael T McCurdy
- Division of Pulmonary & Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Osman Ali
- Division of Pulmonary & Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anna Hall
- Department of Critical Care, King's College London, Guy's & St Thomas' NHS Foundation Hospital, London, SE1 7EH, UK
| | - Huaizhen Chen
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Emory University, Emory St. Joseph's Hospital, 5665 Peachtree Dunwoody Road, Atlanta, GA, 30342, USA
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' NHS Foundation Hospital, London, SE1 7EH, UK
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Campbell DJ. Letter by Campbell Regarding Article, "γδ T Cells Mediate Angiotensin II-Induced Hypertension and Vascular Injury". Circulation 2017; 136:2198-2199. [PMID: 29180498 DOI: 10.1161/circulationaha.117.029831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Duncan J Campbell
- St. Vincent's Institute of Medical Research, and Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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11
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Caillon A, Huo KG, Paradis P, Schiffrin EL. Response by Caillon et al to Letter Regarding Article, "γδ T Cells Mediate Angiotensin II-Induced Hypertension and Vascular Injury". Circulation 2017; 136:2200-2201. [PMID: 29180499 DOI: 10.1161/circulationaha.117.030517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antoine Caillon
- Lady Davis Institute for Medical Research (A.C., K.-G.H., P.P., E.L.S.)
| | - Ku-Geng Huo
- Lady Davis Institute for Medical Research (A.C., K.-G.H., P.P., E.L.S.)
| | - Pierre Paradis
- Lady Davis Institute for Medical Research (A.C., K.-G.H., P.P., E.L.S.)
| | - Ernesto L Schiffrin
- Lady Davis Institute for Medical Research (A.C., K.-G.H., P.P., E.L.S.).,Department of Medicine (E.L.S.), Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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12
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Austin AW, Kushnick MR, Knutson MJ, McGlynn ML, Patterson SM. Resting Plasma Lipids and Cardiovascular Reactivity to Acute Psychological Stress. J PSYCHOPHYSIOL 2015. [DOI: 10.1027/0269-8803/a000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Prior research suggests that hyperlipidemia is associated with elevated blood pressure responses to acute stress but whether lipid levels influence underlying cardiac and vascular determinants of blood pressure during stress is not known. Thus, we examined whether lipids were associated with stress-induced blood pressure responses and responses of stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR). In 19 healthy university students (15 men), blood was drawn to measure lipid levels (triglycerides, low-density lipoprotein cholesterol [LDL-c], high-density lipoprotein cholesterol [HDL-c], total cholesterol) after a 10-min rest period. Participants then completed a 6-min mental arithmetic stressor and a 3-min cold pressor (separated by a 10-min recovery). This procedure was repeated twice, approximately 6 weeks apart. Lipids and hemodynamic values were averaged across the two sessions. Multiple linear regression analyses revealed that a model including LDL-c, HDL-c, and triglycerides significantly predicted diastolic blood pressure (DBP), R2adj = .45, p = .007, and systolic blood pressure (SBP) cold pressor reactivity, R2adj = .35, p = .023. Individually, only LDL-c significantly predicted DBP, β = .64, p = .003, and SBP cold pressor reactivity, β = .64, p = .005. The same model marginally predicted CO, R2adj = .24, p = .069, and TPR, R2adj = 21, p = .091, reactivity to mental arithmetic, but only triglycerides were independently associated with CO, β = −.63, p = .012, and TPR, β = .54, p = .029 reactivity. Lipids were not associated with heart rate (HR) or SV reactivity. LDL-c was positively associated with the blood pressure response to the cold pressor, whereas triglycerides were positively and negatively associated with the TPR and CO responses, respectively, to mental arithmetic. Endothelial dysfunction and greater release of vasoconstrictors in those with high lipids may explain these relationships.
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Affiliation(s)
- Anthony W. Austin
- Department of Social and Behavioral Sciences, University of Arkansas at Pine Bluff, AR, USA
| | - Michael R. Kushnick
- School of Applied Health Sciences and Wellness, Exercise Physiology and Biochemistry Laboratories, Ohio University, Athens, OH, USA
| | - Michael J. Knutson
- School of Applied Health Sciences and Wellness, Exercise Physiology and Biochemistry Laboratories, Ohio University, Athens, OH, USA
| | - Mark L. McGlynn
- School of Applied Health Sciences and Wellness, Exercise Physiology and Biochemistry Laboratories, Ohio University, Athens, OH, USA
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Kuroki MT, Fink GD, Osborn JW. Comparison of arterial pressure and plasma ANG II responses to three methods of subcutaneous ANG II administration. Am J Physiol Heart Circ Physiol 2014; 307:H670-9. [PMID: 24993045 DOI: 10.1152/ajpheart.00922.2013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Angiotensin II (ANG II)-induced hypertension is a commonly studied model of experimental hypertension, particularly in rodents, and is often generated by subcutaneous delivery of ANG II using Alzet osmotic minipumps chronically implanted under the skin. We have observed that, in a subset of animals subjected to this protocol, mean arterial pressure (MAP) begins to decline gradually starting the second week of ANG II infusion, resulting in a blunting of the slow pressor response and reduced final MAP. We hypothesized that this variability in the slow pressor response to ANG II was mainly due to factors unique to Alzet pumps. To test this, we compared the pressure profile and changes in plasma ANG II levels during subcutaneous ANG II administration (150 ng·kg(-1)·min(-1)) using either Alzet minipumps, iPrecio implantable pumps, or a Harvard external infusion pump. At the end of 14 days of ANG II, MAP was highest in the iPrecio group (156 ± 3 mmHg) followed by Harvard (140 ± 3 mmHg) and Alzet (122 ± 3 mmHg) groups. The rate of the slow pressor response, measured as daily increases in pressure averaged over days 2-14 of ANG II, was similar between iPrecio and Harvard groups (2.7 ± 0.4 and 2.2 ± 0.4 mmHg/day) but was significantly blunted in the Alzet group (0.4 ± 0.4 mmHg/day) due to a gradual decline in MAP in a subset of rats. We also found differences in the temporal profile of plasma ANG II between infusion groups. We conclude that the gradual decline in MAP observed in a subset of rats during ANG II infusion using Alzet pumps is mainly due to pump-dependent factors when applied in this particular context.
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Affiliation(s)
- Marcos T Kuroki
- Graduate Program in Neuroscience and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota; and
| | - Gregory D Fink
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan
| | - John W Osborn
- Graduate Program in Neuroscience and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota; and
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Campbell DJ. Evolving concepts of the renin–angiotensin system. Introduction. Clin Exp Pharmacol Physiol 2014; 40:525-6. [PMID: 23735053 DOI: 10.1111/1440-1681.12134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Duncan J Campbell
- St Vincent's Institute of Medical Research, Melbourne, Vic. 3065, Australia.
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Campbell DJ. Clinical relevance of local Renin Angiotensin systems. Front Endocrinol (Lausanne) 2014; 5:113. [PMID: 25071727 PMCID: PMC4095645 DOI: 10.3389/fendo.2014.00113] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/30/2014] [Indexed: 12/12/2022] Open
Affiliation(s)
- Duncan J. Campbell
- St. Vincent’s Institute of Medical Research, Fitzroy, VIC, Australia
- Department of Medicine, University of Melbourne, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- *Correspondence:
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