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Effects of losartan + L-arginine on nitric oxide production, endothelial cell function, and hemodynamic variables in patients with heart failure secondary to coronary heart disease.
Am J Cardiol. 2006 Jul 15; 98(2):172-7.AJ

Abstract

The purpose of the present study was to evaluate the effects of losartan and the combination of losartan and L-arginine on endothelial function and hemodynamic variables in patients with heart failure (HF). Endothelium-dependent vasodilation is impaired in patients with HF. It was hypothesized that the administration of losartan and the combination of losartan and L-arginine might increase nitric oxide production and have a beneficial additive effect on endothelial function and hemodynamic variables in patients with HF. Nine patients with HF (ejection fraction<35%) were given losartan 50 mg orally on 2 consecutive days. On the second day, 1 hour after losartan 50 mg administration, L-arginine 20 g was given by intravenous infusion. Endothelial function in the form of endothelium-dependent brachial artery flow-mediated vasodilation (FMV) was measured by ultrasound. Hemodynamic variables were estimated using Doppler echocardiography at baseline and at 2 and 4 hours after losartan alone and after combination therapy. Urinary levels of nitrite (NO2) or nitrate (NO3) were measured. Four hours after losartan administration, significant reductions in systemic vascular resistance and estimated end-systolic elastase were observed. On the second day, 1 hour after L-arginine infusion, an additive hemodynamic effect was observed, with significant increases in the cardiac index and stroke volume and significant reductions in systemic vascular resistance and calculated left ventricular end-diastolic pressure. A trend toward improved FMV was observed with losartan alone, but without statistical significance. Combination therapy significantly improved postintervention FMV compared with baseline. The increase in urinary nitric oxide excretion after losartan treatment and combination therapy was significantly correlated with improved hemodynamic variables and improved FMV. In conclusion, losartan induces significant afterload reduction, reduced contractility, and increased nitric oxide urinary excretion. The combination of L-arginine and losartan seems to have superior effects on hemodynamic variables and endothelium-dependent vasodilation compared with losartan alone.

Authors+Show Affiliations

Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16828587

Citation

Koifman, Bella, et al. "Effects of Losartan + L-arginine On Nitric Oxide Production, Endothelial Cell Function, and Hemodynamic Variables in Patients With Heart Failure Secondary to Coronary Heart Disease." The American Journal of Cardiology, vol. 98, no. 2, 2006, pp. 172-7.
Koifman B, Topilski I, Megidish R, et al. Effects of losartan + L-arginine on nitric oxide production, endothelial cell function, and hemodynamic variables in patients with heart failure secondary to coronary heart disease. Am J Cardiol. 2006;98(2):172-7.
Koifman, B., Topilski, I., Megidish, R., Zelmanovich, L., Chernihovsky, T., Bykhovsy, E., & Keren, G. (2006). Effects of losartan + L-arginine on nitric oxide production, endothelial cell function, and hemodynamic variables in patients with heart failure secondary to coronary heart disease. The American Journal of Cardiology, 98(2), 172-7.
Koifman B, et al. Effects of Losartan + L-arginine On Nitric Oxide Production, Endothelial Cell Function, and Hemodynamic Variables in Patients With Heart Failure Secondary to Coronary Heart Disease. Am J Cardiol. 2006 Jul 15;98(2):172-7. PubMed PMID: 16828587.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of losartan + L-arginine on nitric oxide production, endothelial cell function, and hemodynamic variables in patients with heart failure secondary to coronary heart disease. AU - Koifman,Bella, AU - Topilski,Ian, AU - Megidish,Ricki, AU - Zelmanovich,Laslo, AU - Chernihovsky,Tamara, AU - Bykhovsy,Elda, AU - Keren,Gad, Y1 - 2006/05/12/ PY - 2005/11/07/received PY - 2006/01/19/revised PY - 2006/01/19/accepted PY - 2006/7/11/pubmed PY - 2006/8/19/medline PY - 2006/7/11/entrez SP - 172 EP - 7 JF - The American journal of cardiology JO - Am J Cardiol VL - 98 IS - 2 N2 - The purpose of the present study was to evaluate the effects of losartan and the combination of losartan and L-arginine on endothelial function and hemodynamic variables in patients with heart failure (HF). Endothelium-dependent vasodilation is impaired in patients with HF. It was hypothesized that the administration of losartan and the combination of losartan and L-arginine might increase nitric oxide production and have a beneficial additive effect on endothelial function and hemodynamic variables in patients with HF. Nine patients with HF (ejection fraction<35%) were given losartan 50 mg orally on 2 consecutive days. On the second day, 1 hour after losartan 50 mg administration, L-arginine 20 g was given by intravenous infusion. Endothelial function in the form of endothelium-dependent brachial artery flow-mediated vasodilation (FMV) was measured by ultrasound. Hemodynamic variables were estimated using Doppler echocardiography at baseline and at 2 and 4 hours after losartan alone and after combination therapy. Urinary levels of nitrite (NO2) or nitrate (NO3) were measured. Four hours after losartan administration, significant reductions in systemic vascular resistance and estimated end-systolic elastase were observed. On the second day, 1 hour after L-arginine infusion, an additive hemodynamic effect was observed, with significant increases in the cardiac index and stroke volume and significant reductions in systemic vascular resistance and calculated left ventricular end-diastolic pressure. A trend toward improved FMV was observed with losartan alone, but without statistical significance. Combination therapy significantly improved postintervention FMV compared with baseline. The increase in urinary nitric oxide excretion after losartan treatment and combination therapy was significantly correlated with improved hemodynamic variables and improved FMV. In conclusion, losartan induces significant afterload reduction, reduced contractility, and increased nitric oxide urinary excretion. The combination of L-arginine and losartan seems to have superior effects on hemodynamic variables and endothelium-dependent vasodilation compared with losartan alone. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/16828587/Effects_of_losartan_+_L_arginine_on_nitric_oxide_production_endothelial_cell_function_and_hemodynamic_variables_in_patients_with_heart_failure_secondary_to_coronary_heart_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)00677-1 DB - PRIME DP - Unbound Medicine ER -