Circulation, Vol 82, 1730-1736, Copyright © 1990 by American Heart Association
K Swedberg, P Eneroth, J Kjekshus and L Wilhelmsen
There is a varying hormonal activation in heart failure. To be able to
evaluate this activation and relate it to prognosis, we took blood samples
at baseline and after 6 weeks from 239 patients with severe heart failure
(all in New York Heart Association class IV) randomized to additional
treatment with enalapril or placebo. In this study (CONSENSUS), which has
previously been reported, there was a significant reduction in mortality
among patients treated with enalapril. The present data show in the placebo
group a significant positive relation between mortality and levels of
angiotensin II (p less than 0.05), aldosterone (p = 0.003), noradrenaline
(p less than 0.001), adrenaline (p = 0.001), and atrial natriuretic factor
(p = 0.003). A similar relation was not observed among the patients treated
with enalapril. Significant reductions in mortality in the groups of
patients treated with enalapril were consistently found among patients with
baseline hormone levels above median values. There were significant
reductions in hormone levels from baseline to 6 weeks in the group of
patients treated with enalapril for all hormones except adrenaline. There
were no correlations between these changes in hormone levels. Summarily,
there is a pronounced but variable neurohormonal activation in heart
failure even in patients with similar clinical findings. This activation is
reduced by enalapril therapy. The results suggest that the effect of
enalapril on mortality is related to hormonal activation in general and the
renin-angiotensin system in particular.
ARTICLES
Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality. CONSENSUS Trial Study Group
Department of Internal Medicine, Gothenburg University, Ostra Hospital, Sweden.
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M. Richards and R. W. Troughton NT-proBNP in heart failure: therapy decisions and monitoring Eur J Heart Fail, March 15, 2004; 6(3): 351 - 354. [Abstract] [Full Text] [PDF]
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F. K Shieh, E. Kotlyar, and F. Sam Aldosterone and cardiovascular remodelling: focus on myocardial failure Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1): 3 - 13. [Abstract] [PDF]
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R. Latini, S. Masson, I. Anand, M. Salio, A. Hester, D. Judd, S. Barlera, A. P Maggioni, G. Tognoni, J. N Cohn, et al. The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT Eur. Heart J., February 2, 2004; 25(4): 292 - 299. [Abstract] [Full Text] [PDF]
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M. Li, C. Zheng, T. Sato, T. Kawada, M. Sugimachi, and K. Sunagawa Vagal Nerve Stimulation Markedly Improves Long-Term Survival After Chronic Heart Failure in Rats Circulation, January 6, 2004; 109(1): 120 - 124. [Abstract] [Full Text] [PDF]
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A. Kjaer, J. Appel, P. Hildebrandt, and C. L. Petersen Basal and exercise-induced neuroendocrine activation in patients with heart failure and in normal subjects Eur J Heart Fail, January 1, 2004; 6(1): 29 - 39. [Abstract] [Full Text] [PDF]
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T. Yamazaki, J.-D. Lee, H. Shimizu, H. Uzui, and T. Ueda Circulating matrix metalloproteinase-2 is elevated in patients with congestive heart failure Eur J Heart Fail, January 1, 2004; 6(1): 41 - 45. [Abstract] [Full Text] [PDF]
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A. Nap, C. N. Belterman, M.-J. Mathy, J. C Balt, M. Pfaffendorf, and P. A van Zwieten Impaired neuronal and vascular responses to angiotensin II in a rabbit congestive heart failure model Journal of Renin-Angiotensin-Aldosterone System, December 1, 2003; 4(4): 220 - 227. [Abstract] [PDF]
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S. Velez-Roa, M. Renard, J.-P. Degaute, and P. van de Borne Peripheral sympathetic control during dobutamine infusion: effects of aging and heart failure J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1605 - 1610. [Abstract] [Full Text] [PDF]
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D. Fraccarollo, P. Galuppo, S. Hildemann, M. Christ, G. Ertl, and J. Bauersachs Additive improvement of left ventricular remodeling and neurohormonal activation by aldosterone receptor blockade with eplerenone and ACE inhibition in rats with myocardial infarction J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1666 - 1673. [Abstract] [Full Text] [PDF]
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S. Hussain, D. E. Dreyfus, R. J. Marcus, R. W. W. Biederman, and R. L. McGill Is spironolactone safe for dialysis patients? Nephrol. Dial. Transplant., November 1, 2003; 18(11): 2364 - 2368. [Abstract] [Full Text] [PDF]
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G. Grassi, G. Seravalle, F. Quarti-Trevano, R. Dell'Oro, G. Bolla, and G. Mancia Effects of Hypertension and Obesity on the Sympathetic Activation of Heart Failure Patients Hypertension, November 1, 2003; 42(5): 873 - 877. [Abstract] [Full Text] [PDF]
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R. S. McKelvie, J.-L. Rouleau, M. White, R. Afzal, J. B. Young, A. P. Maggioni, P. Held, and S. Yusuf Comparative impact of enalapril, candesartan or metoprolol alone or in combination on ventricular remodelling in patients with congestive heart failure Eur. Heart J., October 1, 2003; 24(19): 1727 - 1734. [Abstract] [Full Text] [PDF]
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J. N. Cohn, M. A. Pfeffer, J. Rouleau, N. Sharpe, K. Swedberg, M. Straub, C. Wiltse, T. J. Wright, and for the MOXCON Investigators Adverse mortality effect of central sympathetic inhibition with sustained-release moxonidine in patients with heart failure (MOXCON) Eur J Heart Fail, October 1, 2003; 5(5): 659 - 667. [Abstract] [Full Text] [PDF]
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B. Pitt, C. T Stier Jr, and S. Rajagopalan Mineralocorticoid receptor blockade: new insights into the mechanism of action in patients with cardiovascular disease Journal of Renin-Angiotensin-Aldosterone System, September 1, 2003; 4(3): 164 - 168. [Abstract] [PDF]
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L. Tavazzi Heart rate as a therapeutic target in heart failure? Eur. Heart J. Suppl., September 1, 2003; 5(suppl_G): G15 - G18. [Abstract] [PDF]
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C Fisher, C Berry, L Blue, J J Morton, and J McMurray N-terminal pro B type natriuretic peptide, but not the new putative cardiac hormone relaxin, predicts prognosis in patients with chronic heart failure Heart, August 1, 2003; 89(8): 879 - 881. [Abstract] [Full Text] [PDF]
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P. B. Adamson, K. J. Kleckner, W. L. VanHout, S. Srinivasan, and W. T. Abraham Cardiac Resynchronization Therapy Improves Heart Rate Variability in Patients with Symptomatic Heart Failure Circulation, July 22, 2003; 108(3): 266 - 269. [Abstract] [Full Text] [PDF]
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A. M. Richards, M. G. Nicholls, E. A. Espiner, J. G. Lainchbury, R. W. Troughton, J. Elliott, C. Frampton, J. Turner, I. G. Crozier, and T. G. Yandle B-Type Natriuretic Peptides and Ejection Fraction for Prognosis After Myocardial Infarction Circulation, June 10, 2003; 107(22): 2786 - 2792. [Abstract] [Full Text] [PDF]
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A. Schafer, D. Fraccarollo, S. K Hildemann, P. Tas, G. Ertl, and J. Bauersachs Addition of the selective aldosterone receptor antagonist eplerenone to ACE inhibition in heart failure: effect on endothelial dysfunction Cardiovasc Res, June 1, 2003; 58(3): 655 - 662. [Abstract] [Full Text] [PDF]
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N. J. Brown Eplerenone: Cardiovascular Protection Circulation, May 20, 2003; 107(19): 2512 - 2518. [Abstract] [Full Text] [PDF]
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B. Bozkurt and D. L. Mann Use of Biomarkers in the Management of Heart Failure: Are We There Yet? Circulation, March 11, 2003; 107(9): 1231 - 1233. [Full Text] [PDF]
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I. S. Anand, L. D. Fisher, Y.-T. Chiang, R. Latini, S. Masson, A. P. Maggioni, R. D. Glazer, G. Tognoni, J. N. Cohn, and for the Val-HeFT Investigators Changes in Brain Natriuretic Peptide and Norepinephrine Over Time and Mortality and Morbidity in the Valsartan Heart Failure Trial (Val-HeFT) Circulation, March 11, 2003; 107(9): 1278 - 1283. [Abstract] [Full Text] [PDF]
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A. Abbate, G. G. L. Biondi-Zoccai, R. Bussani, A. Dobrina, D. Camilot, F. Feroce, R. Rossiello, F. Baldi, F. Silvestri, L. M. Biasucci, et al. Increased myocardial apoptosis in patients with unfavorable left ventricular remodeling and early symptomatic post-infarction heart failure J. Am. Coll. Cardiol., March 5, 2003; 41(5): 753 - 760. [Abstract] [Full Text] [PDF]
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