Circulation, Vol 66, 135-142, Copyright © 1982 by American Heart Association
RJ Cody, KW Franklin, J Kluger and JH Laragh
We assessed the hemodynamic and hormonal response to tilt and the
baroreceptor response in 12 patients in sinus rhythm with severe chronic
congestive heart failure. We also assessed the response to acute (n = 12)
and chronic (n = 8) converting-enzyme inhibition with captopril. The
control tilt was characterized by high cardiac filling pressures, absence
of significant peripheral pooling and apparent absence of afferent stimuli
for hemodynamic and hormonal response. After acute captopril, the
hemodynamic response to tilt was improved, but not normalized. The chronic
response was characterized by the absence of a reflex increase of systemic
vascular resistance on tilt despite peripheral pooling. Five patients
developed orthostatic hypotension, but responded to acute infusion of 0.9%
sodium chloride. Efferent sympathetic activity (response to cold pressor)
was abnormal during the control study, but indistinguishable from normal
subjects by the time of chronic captopril therapy. This paralleled an
improved responsiveness of plasma catecholamines during chronic tilt. The
Valsalva maneuver remained abnormal. There was a distinct absence of the
normally anticipated heart rate increase on tilt, suggesting a
parasympathetic abnormality.
ARTICLES
Mechanisms governing the postural response and baroreceptor abnormalities in chronic congestive heart failure: effects of acute and long-term converting-enzyme inhibition
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