Renal hemodynamic effects of vasodilation with nifedipine and hydralazine in patients with heart failure
| Autor: | Shahbudin H. Rahimtoola, Uri Elkayam, Vito M. Campese, Laura Weber, Shaul G. Massry |
|---|---|
| Rok vydání: | 1984 |
| Předmět: |
Adult
medicine.medical_specialty Time Factors Nifedipine Hemodynamics Blood Pressure urologic and male genital diseases Renal Veins Renal Circulation Random Allocation Renal Artery Internal medicine medicine Humans Cardiac Output Aged Heart Failure Kidney Renal circulation business.industry Hydralazine Middle Aged medicine.disease medicine.anatomical_structure Renal blood flow Heart failure Vascular resistance Cardiology Vascular Resistance business Cardiology and Cardiovascular Medicine medicine.drug Glomerular Filtration Rate |
| Zdroj: | Journal of the American College of Cardiology. 4(6):1261-1267 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/s0735-1097(84)80147-3 |
| Popis: | The central and renal hemodynamic effects of nifedipine were evaluated in nine patients with severe chronic congestive heart failure. Oral nifedipine (34 ± 22 mg, mean ± standard deviation) was associated with a decrease in systemic vascular resistance from 1,748 ± 436 to 1,321 ± 302 dynes·s·cm−5(p < 0.001) and mean arterial blood pressure from 96 ± 11 to 87 ± 6 mm Hg (p < 0.05) and with an increase in cardiac output from 4.2 ± 1.1 to 4.9 ± 1.2 liters/min (p < 0.001). Although renal vascular resistance decreased from 11,988 ± 2,256 to 10,286 ± 3,011 dynes·s·cm−5(p < 0.05), no significant change was seen in renal blood flow (599 ± 120 to 640 ± 162 ml/min), glomerular filtration rate (62 ± 18 to 62 ± 17 ml/min), filtration fraction (18 ± 5 to 17 ± 6%), the ratio of renal/systemic vascular resistance (7.0 ± 1.0 to 7.9 ± 1.8) and the ratio of renal blood flow/cardiac output (0.15 ± 0.02 to 0.13 ± 0.03).Intravenous hydralazine (10 ± 5 mg), given to eight of the patients in a randomized crossover design, resulted in a larger increase in cardiac output than did nifedipine (38 ± 7 versus 19 ± 10%, p < 0.001) and in an increase in total renal blood flow from 570 ± 152 to 645 ± 174 ml/min (p < 0.001). Renal vascular resistance decreased from 12,080 ± 2,934 to 10,153 ± 2,372 dynes·s·cm−5(p < 0.001). The ratio renal/systemic vascular resistance, however, increased from 6.9 ± 0.9 to 8.5 ± 1.3 (p < 0.001), and the ratio of renal blood flow/cardiac output decreased from 0.15 ± 0.02 to 0.13 ± 0.03 (p < 0.001). In spite of the improvement in renal blood flow, no change was noted in glomerular filtration rate (57 ± 18 to 57 ± 11 ml/min) or filtration fraction (16 ± 3 to 15 ± 3%).This study demonstrates that the strong arteriolar vasodilation of nifedipine involves the renal circulation and decreases abnormally elevated renal vascular resistance. This effect, however, does not lead to an improvement of renal blood flow or glomerular filtration rate. Vasodilation with hydralazine results in significant improvement of renal perfusion, although renal blood flow does not increase proportionately as much as the total cardiac output. Despite improvement in renal perfusion, hydralazine, similar to nifedipine, does not increase glomerular filtration rate. |
| Databáze: | OpenAIRE |
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