Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study was designed to assess the influence of the activation status of the renin angiotensin system (RAS) on the hemodynamic effects of EXP 3174 (an angiotensin AT1 receptor antagonist) and enalaprilat (an angiotensin converting enzyme inhibitor) in tachycardia-induced heart failure. Thirteen dogs were chronically instrumented to measure left ventricular (LV) pressure, its first time derivative (LV dP/dt), atrial and aortic pressures, and cardiac output. EXP 3174 (0.1 mg/kg, i.v.) or enalaprilat (1 mg/kg, i.v.) were administered in conscious dogs with heart failure induced by right ventricular pacing (250 beats/min, 3 weeks). EXP 3174 and enalaprilat produced significant vasodilation but the effects of EXP 3174 on mean aortic pressure (MAP), cardiac output, and total peripheral resistance (TPR) were only 50% of those produced by enalaprilat. When dogs were grouped according to their baseline plasma renin activity (PRA) values, in dogs with normal PRA (0.5 +/- 0.1 ng/ml/h) EXP 3174 did not produce significant change in MAP and TPR, while enalaprilat decreased significantly MAP and TPR. In contrast, in dogs with high PRA (6.7 +/- 3.2 ng/ml/h), EXP 3174 produced significant reductions in MAP and TPR, which were similar to those produced by enalaprilat. Thus, in conscious dogs with heart failure, enalaprilat is effective whether the RAS is activated or not. In contrast, EXP 3174 is effective only when the RAS is activated. These results may help in the choice of inhibitors of the RAS in heart failure.
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PMID:Comparison between angiotensin receptor antagonism and converting enzyme inhibition in heart failure. Differential acute effects according to the renin-angiotensin system activation. 1032 61

The angiotensin II receptor blockers (ARBs) are safe and effective agents in the treatment of hypertension, and they have potential in treating other cardiovascular disorders such as heart failure. These drugs share a common mechanism of action: They selectively block the angiotensin type 1 (AT1) receptor. A new ARB, candesartan cilexetil is a prodrug that is converted completely into the active metabolite candesartan during gastrointestinal absorption, whereas losartan is converted partially by hepatic metabolism into the more active compound EXP 3174. Valsartan and irbesartan are active in their own right. These ARBs differ pharmacologically in terms of their affinity for the AT1 receptor, the mechanism by which they block the receptor, and the duration of their receptor-blocking activity. In radioligand-binding studies, candesartan had a slightly higher affinity for the AT1 receptor than the other ARBs. In the rabbit aorta, candesartan blocked angiotensin II-induced contractions in an insurmountable manner, whereas losartan blocked the contractions competitively, and EXP 3174, valsortan and irbesartan blocked the contractions in a manner intermediate between competitive and insurmountable antagonism. The insurmountable antagonism exhibited by candesartan likely reflects its long-lasting blockade of the AT1 receptor due to a slow dissociation rate. This suggests that candesartan will exhibit a longer duration of action than would be predicted simply from its pharmacokinetic elimination half-life. Comparative clinical trials with several ARBs are needed to define the clinical significance of these pharmacologic differences.
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PMID:Significance of angiotensin type 1 receptor blockade: why are angiotensin II receptor blockers different? 1058 89