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Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115
We examined whether physiological
stimulation of the endogenous renin-angiotensin system results in
impaired endothelium-dependent vasodilatation in forearm resistance
vessels of healthy subjects and whether this impairment can be
prevented by angiotensin II type 1 receptor blockade. A low-sodium diet
was administered to 27 volunteers who were randomized to concomitant
treatment with losartan (100 mg once daily) or matched placebo in a
double-blind fashion. Forearm blood flow was assessed by venous
occlusion plethysmography at baseline and after 5 days.
Endothelium-dependent and -independent vasodilation was assessed by
intra-arterial infusion of methacholine and verapamil, respectively.
The low-sodium diet resulted in significantly decreased urine sodium
excretion (placebo: 146 ± 64 vs. 10 ± 9 meq/24 h,
P < 0.001; losartan: 141 ± 56 vs. 14 ± 14 meq/24 h, P < 0.001) and increased plasma renin
activity (placebo: 1.0 ± 0.5 vs. 5.0 ± 2.5 ng · ml
1 · h
1,
P < 0.001; losartan: 3.8 ± 7.2 vs. 19.1 ± 11.2 ng · ml
1 · h
1,
P = 0.006) in both the losartan and placebo groups.
With the baseline study as the reference, the diet intervention was not associated with any significant change in endothelium-dependent vasodilation to methacholine in either the placebo (P = 0.74) or losartan (P = 0.40) group. We conclude that
short-term physiological stimulation of the renin-angiotensin system
does not cause clinically significant endothelial dysfunction. Losartan
did not influence endothelium-dependent vasodilation in humans with a
stimulated renin-angiotensin system.
endothelium; vasodilation; nitric oxide; angiotensin II
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