PMID- 2239664
OWN - NLM
STAT- MEDLINE
DCOM- 19901204
LR  - 20190626
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 120
IP  - 5
DP  - 1990 Nov
TI  - ACE inhibition improves vagal reactivity in patients with heart failure.
PG  - 1120-9
AB  - The deranged autonomic control of heart rate was studied in 34 patients with 
      heart failure (New York Heart Association [NYHA] functional class II to III) by 
      examining the carotid sinus baroreflex. The carotid sinus baroreceptors were 
      stimulated by graded suction. The slope of the regression line between increases 
      in cycle length and the degree of neck suction was taken as an index of 
      baroreflex sensitivity. The reflex response is mediated by a selective increase 
      of vagal efferent activity. Baroreflex sensitivity therefore represents a measure 
      of vagal reactivity. Using multiple regression analysis, baroreflex sensitivity 
      (BS) correlated positively to stroke volume index (SVI) and inversely to plasma 
      renin activity (PRA) and to age: BS = 0.47 SVI - 0.38 PRA - 0.23 age + constant 
      (r = 0.74; p less than 0.0005). In addition to digitalis and diuretics, 
      angiotensin-converting enzyme (ACE) inhibitors (captopril or enalapril) were 
      given to 16 patients for a mean of 17 +/- 3 days. The patients with hemodynamic 
      improvement (group A) exhibited improved baroreflex sensitivity (1.4 +/- 0.4 to 
      3.6 +/- 1.2 msec/mm Hg; p less than 0.01). Baroreflex sensitivity remained 
      unchanged (3.1 +/- 0.8 to 2.4 +/- 1.0 msec/mm Hg; n.s.) in the patients without 
      hemodynamic improvement (group B). The increase in reflex sensitivity did not 
      correlate with hemodynamic alterations. Baroreflex sensitivity during ACE 
      inhibition (BSD) was only related to the baseline baroreflex sensitivity (BSB): 
      BSD = 2.8 BSB - 0.46 (r = 0.84; p less than 0.005). In patients with heart 
      failure, reflex bradycardia decreases with age and with PRA and increases with 
      stroke volume. Chronic therapy with ACE inhibitors enhances vagal reactivity in 
      patients with hemodynamic improvement.
FAU - Osterziel, K J
AU  - Osterziel KJ
AD  - Department of Internal Medicine, Ruprecht-Karls-University, Heidleberg, W. 
      Germany.
FAU - Dietz, R
AU  - Dietz R
FAU - Schmid, W
AU  - Schmid W
FAU - Mikulaschek, K
AU  - Mikulaschek K
FAU - Manthey, J
AU  - Manthey J
FAU - Kubler, W
AU  - Kubler W
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 69PN84IO1A (Enalapril)
RN  - 9G64RSX1XD (Captopril)
SB  - IM
CIN - Am Heart J. 1991 Dec;122(6):1792. PMID: 1957783
MH  - Adult
MH  - Aged
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Captopril/therapeutic use
MH  - Cardiomyopathy, Dilated/drug therapy/*physiopathology
MH  - Carotid Sinus/drug effects/physiopathology
MH  - Coronary Disease/drug therapy/*physiopathology
MH  - Enalapril/therapeutic use
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pressoreceptors/drug effects/physiopathology
MH  - Reflex/drug effects/physiology
MH  - Vagus Nerve/drug effects/*physiopathology
EDAT- 1990/11/01 00:00
MHDA- 1990/11/01 00:01
CRDT- 1990/11/01 00:00
PHST- 1990/11/01 00:00 [pubmed]
PHST- 1990/11/01 00:01 [medline]
PHST- 1990/11/01 00:00 [entrez]
AID - 0002-8703(90)90125-H [pii]
AID - 10.1016/0002-8703(90)90125-h [doi]
PST - ppublish
SO  - Am Heart J. 1990 Nov;120(5):1120-9. doi: 10.1016/0002-8703(90)90125-h.