Differing effects of the vasodilator drugs, prazosin and diazoxide on plasma renin activity in the dog

Ventricular dysrhythmias, left ventricular hypertrophy, and sudden death

Left ventricular hypertrophy has been documented to be a powerful risk factor for sudden death, acute myocardial infarction, and other cardiovascular morbidity and mortality. The major determinant of left ventricular mass is the hemodynamic burden. However, the hypertrophic process is modified by demographic parameters (age, sex, race), nutritional parameters (salt intake, alcohol, obesity), and neuroendocrine factors (angiotensin, catecholamines, growth hormones, etc.). Ventricular ectopy and more serious arrhythmias are commonly seen in patients with left ventricular hypertrophy. Specific antihypertensive therapy will reduce left ventricular hypertrophy, although not all antihypertensive drugs are equipotent in this regard. A reduction in left ventricular hypertrophy has been shown to diminish left-ventricular-hypertrophy-associated arrhythmias. However, it remains to be shown that patients with left ventricular hypertrophy and ventricular ectopy are at a higher risk of sudden death than those without ventricular ectopy and that the reduction of left-ventricular-hypertrophy-associated ventricular ectopy indeed confers a clinical benefit that exceeds the one from the reduction in arterial pressure alone.

Ventricular performance in spontaneously hypertensive rats (SHR) with reduced cardiac mass

This study was designed to investigate the effect of 4 weeks of captopril treatment on cardiac mass and performance in spontaneously hypertensive rats (SHR). Left (LV) and right (RV) ventricular mass of SHR and normotensive WKY rats was reduced (p less than 0.01). Mean arterial pressure (MAP) and total peripheral resistance index (TPRI) in the treated SHR and WKY were reduced; cardiac (CI) and stroke (SI) indices remained unaltered in SHR but increased in WKY. Ventricular performance (i.e., cardiac pumping ability), assessed by rapid blood infusion, did not differ between untreated SHR and WKY, and between treated and untreated WKY rats. However, the ventricular performance curves for the treated SHR shifted down and to the right from the untreated SHR (p less than 0.01). Moreover, when MAP of treated SHR (with regressed LV mass) was elevated to their pretreatment levels, cardiac performance curves shifted further rightward and downward. In contrast, the performance curves of treated WKY whose MAP was also elevated to the level of untreated WKY were no different from those of untreated WKY. These data demonstrate that captopril treatment (at doses used in this study) reduced MAP in SHR through decreased TPRI while decreasing biventricular mass. Furthermore, the cardiac-pumping ability of previously hypertrophied SHR hearts was reduced, suggesting that certain antihypertensive agents that diminish cardiac mass could produce impaired cardiac function when called upon to increase performance (e.g., when MAP is suddenly raised).

Effect of acute administration of prazosin on blood pressure, heart rate and plasma renin level in the conscious normotensive rat

This study investigated whether the specific alpha-antagonist, prazosin, stimulated basal plasma renin levels and heart rate. Furthermore the beta-adrenergic nervous system was also investigated to ascertain whether it was involved in this effect. Prazosin (0.1 or 1 mg/kg) was injected subcutaneously (s.c.) to conscious normotensive rats, either alone or in combination with the beta-adrenoceptor antagonist, DL-propranolol (1 or 3 mg/kg). Rats bore chronically implanted dorsal aorta cannula for measurement of blood pressure and heart rate and blood sampling for renin determinations. Acute administration of prazosin (1 mg/kg, s.c.) produced a fall in mean arterial pressure accompanied by renin release and tachycardia. A tenfold lower dose of prazosin did not alter blood pressure or heart rate but did stimulate renin release. Acute administration of DL-propranolol, (1 or 3 mg/kg, s.c.) produced falls in blood pressure and heart rate but did not affect plasma renin level. Combinations of prazosin with propranolol gave falls in blood pressure similar to those predicted on the basis of a simple addition of the effects of the two drugs given separately. Prazosin-induced tachycardia and renin release were attenuated by propranolol. It appears that prazosin produces renin release and tachycardia via stimulation of the beta-adrenergic adrenoceptor.

Alpha 1-adrenergic blockade and cardiovascular pressor responses in essential hypertension

The effects of selective alpha 1-adrenergic blockade with terazosin on blood pressure and cardiovascular pressor responsiveness were assessed in 17 subjects with mild to moderate essential hypertension (mean age, 48 +/- 2 [SEM] years). As compared with a 2-week placebo period, 8 weeks of terazosin treatment (mean dose, 10.5 +/- 1.7 mg/day) caused a fall of supine (from 153/103 +/- 3/2 to 143/96 +/- 4/2 mm Hg; p less than 0.025) and upright (from 145/106 +/- 4/2 to 131/94 +/- 5/3 mm Hg; p less than 0.01) arterial pressure; a marked blunting of cardiovascular pressor responsiveness to norepinephrine, as judged from the pressor dose (from 73 +/- 9 to 2156 +/- 496 ng/kg/min; p less than 0.02) and from the rightward shift (p less than 0.01) of the plasma concentration-blood pressure response curve; and a slight increase in plasma norepinephrine concentration (from 37.7 +/- 3.3 to 52.2 +/- 7.8 ng/dl; p less than 0.01). Heart rate, body weight, exchangeable sodium, blood volume, and norepinephrine plasma clearance; plasma epinephrine, renin, angiotensin II, and aldosterone levels; the relationships between angiotensin II-induced increases in arterial pressure or plasma aldosterone and the concomitant increments of plasma angiotensin II; and heart rate responsiveness to isoproterenol did not change significantly after terazosin treatment. These findings suggest that the fall of arterial pressure induced by selective alpha 1-adrenergic blockade in subjects with essential hypertension is associated with, and probably explained by, inhibition of alpha 1-mediated, noradrenergic-dependent vasoconstriction. alpha 1-Adrenergic receptor antagonism did not modify body sodium concentration, the adrenomedullary component of the sympathetic nervous system, angiotensin II levels, or beta-adrenergic dependent mechanisms.

[Plasma renin activity and prostaglandin E2 in hypotension induced by nicergoline]

The hypotensive actions of nicergoline, a new alpha 1-adrenoreceptor blocking agent, were studied in six dogs during stable anaesthesia under mechanical ventilation. Systemic haemodynamic parameters were measured before the infusion of nicergoline (500 micrograms X kg-1 in 5 min), and regularly after it during 2 h. Plasma renin activity (PRA), right atrial (V PGE2) and arterial (A PGE2) prostaglandin E2 concentrations measured by radio-immunoassay were collected before, and 10 and 20 min after nicergoline infusion. The mean aortic pressure fell to its lowest figure (-30%) at the 5th min, this being maintained for 45 min. Heart rate and cardiac output remained unchanged. Pulmonary wedge pressure (p less than 0.01) and central venous pressure (p less than 0.05) decreased. All parameters reached their control values in 120 min. PRA was unchanged. V PGE2 (p less than 0.01) and pulmonary extraction in PGE2 (V PGE2 - A PGE2/V PGE2) (p less than 0,05) increased whilst A PGE2 was unmodified. The fall in mean aortic pressure was linked (p less than 0.001) to the increase in V PGE2. Nicergoline infusion induced hypotension by reducing vascular tone of resistance and capacitance beds. Hypotension was related to the vasoplegia and to an inhibition of the rapid pressor control mechanisms. The reasons for the lack of renin release were unknown. V PGE2 release was stimulated by the hypotension. The increase in pulmonary extraction in PGE2 was involved in the maintenance of A PGE2 concentration. Nicergoline gave mild hypotension without reflex sympathetic activation. Its alpha-adrenoreceptor blocking properties were similar to those of prazosin.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoamine oxidase and semicarbazide-sensitive amine oxidase in spontaneously hypertensive and in normotensive control rats

The aim of the present work was to compare monoamine oxidase (MAO) and semicarbazide sensitive amine oxidase (SSAO) activity in several tissues from spontaneously hypertensive (SHR) and normotensive Wistar-Kyoto rats (WKY). Contribution of MAO-A, -B and SSAO to the metabolism of each substrate in each tissue was defined from experiments where the decrease of oxidative deamination of each substrate at a given concentration was measured as a function of increasing concentrations of a selective MAO-A, -B or SSAO inhibitor. In the heart, aorta and, to a lesser extent, the femoral arteries MAO-A activity was higher in SHR than in WKY. Similarly in the liver the enzyme activity was higher in SHR than in WKY but was due to the -B form of MAO. In all the other tissues studied (duodenum, brain, lungs, adrenals and kidneys) no difference in MAO-A, MAO-B or SSAO activity was found between SHR and WKY, except for the kidneys and brain, if the differences in the weights of these organs in SHR are taken into account.

Vasodilator therapy in chronic congestive heart failure

Vasodilator agents are relatively new additions to the armamentarium for the management of patients with congestive heart failure. Myocardial failure, irrespective of the aetiology, tends to create a vicious cycle characterised by reduced cardiac output and elevated systemic vascular resistance, which further decrease cardiac output by increasing left ventricular ejection impedance. The rationale for the use of vasodilators is to interrupt the vicious cycle by decreasing the left ventricular ejection impedance by peripheral vasodilatation. Although most vasodilator agents produce qualitatively similar haemodynamic responses, quantitatively their haemodynamic effects differ considerably. Knowledge of the haemodynamic effects of the various vasodilators helps in the selection of a particular drug for the management of such patients. This article reviews the mechanisms of action, haemodynamic effects, pharmacokinetics, clinical usage and adverse effects of non-parenteral vasodilator agents currently available for the management of patients with chronic heart failure.

Prazosin depression of baroreflex function in hypertensive man

Prazosin is a post synaptic alpha adrenergic blocker effective in hypertension, whose hypotensive effect is unaccompanied by reflex tachycardia or hyperreninemia, nor by other evidence of increased sympathetic activity. We studied the baroreceptor reflex arc as a potential mediator of these effects. Twenty-two essential hypertensive men were treated with prazosin alone versus placebo, and experienced a blood pressure fall (from 114.8 +/- 3.6 down to 101.1 +/- 2.5 mmHg, p less than 0.005) unaccompanied by any change in heart rate, plasma renin activity, or several other indices of sympathetic nervous system activity (plasma dopamine-beta-hydroxylase activity; urinary excretion of free catecholamines and vanillyl mandelic acid; all p less than 0.1). Concomitant with the blood pressure fall, there was a significant depression of baroreflex arc sensitivity, from 11.4 +/- 2.0 ms/mmHg down to 6.6 +/- 1.9 ms/mmHg (p less than 0.05), without an associated change in cardiac vagal inhibition (291.2 +/- 46.2 versus 300.3 +/- 19.2 ms, p greater than 0.1). Baroreflex arc sensitivity depression may in part explain the lack of reflex sympathetic outflow noted during prazosin treatment of hypertension.

Effects of chronic prazosin treatment on the renin-angiotensin-aldosterone system in man

The effects of chronic prazosin treatment (3 mg/day for three weeks) on plasma renin activity (PRA) and plasma aldosterone (PA) levels were evaluated in 12 hypertensive patients, under conditions of metabolic balance. After three weeks of drug administration no significant change occurred in PRA as well as PA levels, with respect to pretreatment values, both in basal conditions and following 2 hours of ambulation. No change was observed in heart rate, while a fall in both systolic (P less than 0.02) and diastolic (P less than 0.05) blood pressure occurred in supine as well as in deambulation-stimulating condition. A mild increase in body weight (P less than 0.05) and a decrease in serum sodium (P less than 0.05) was induced by prazosin treatment. These findings are in keeping with the pharmacologic properties of prazosin, which is a selective blocker of postsynaptic alpha adrenoreceptors and therefore lowers vascular resistance without reflex sympathetic overactivity. The moderate volume expansion after prazosin does not appear to be aldosterone mediated.

Rapid control of serious high blood pressure with single large oral doses of prazosin

With precautions, single large oral doses of prazosin (approximately 5 mg) may be used as a substitute for parenterally administered antihypertensive agents.

Prazosin does not alter canine renin release in response to systemic hypotension or intrarenal isoprenaline and prostaglandin I2 infusion

1. The effect of a hypotensive dose of intravenous prazosin (0.2 mg/kg) on heart rate and plasma renin activity was evaluated in anaesthetized mongrel dogs pretreated with indomethacin. 2. The effect of prazosin on the renin release elicited by the beta-adrenoceptor agonist isoprenaline and by prostaglandin I2 was also evaluated. 3. Prazosin administration was associated with a significant increase in heart rate and increase in plasma renin activity. 4. Prazosin did not interfere with the increase in plasma renin activity in response to either isoprenaline or prostaglandin I2. 5. We conclude that prazosin is not a unique peripheral vasodilator since hypotensive doses are associated with an increase in heart rate and plasma renin activity. In addition, prazosin does not inhibit the release of renin induced by either isoprenaline or prostaglandin I2.

Effects of prazosin on blood pressure and plasma renin activity during onset and withdrawal of action in the anaesthetized rat

1. The effects of single intramuscular injections of prazosin, 0.1 mg/kg, upon blood pressure, heart rate and plasma renin activity, were studied, over 24 h, in groups of anaesthetized rats, control rats receiving 0.9% saline. 2. Within 6 min of prazosin administration, heart rate fell by 50 beats/min (s.e.m = 19) and blood pressure by 40 mmHg (s.e.m. = 8). Starting levels were regained within 90 min and 16 h of injection, respectively, and thereafter both parameters remained unaltered. Plasma renin activity showed a slight though insignificant rise during the initial hypotension, but subsequently fell to 32% of the control level. 3. The hypotensive response to prazosin, unlike that to the centrally acting agents clonidine or guanfacine, was not followed by overshoots in blood pressure, heart rate or plasma renin activity. Instead, suppression of plasma renin activity was demonstrable after re-establishment of control blood pressure.