Journal of Applied Physiology AJP: Advances in Physiology Education
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J Appl Physiol 85: 731-737, 1998;
8750-7587/98 $5.00
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Vol. 85, Issue 2, 731-737, August 1998

Angiotensin II mediates systemic rebound hypertension after cessation of prostacyclin infusion in sheep

Ivan M. Robbins1, Leslie L. Cuiper1, C. Michael Stein2, Alastair J. J. Wood2, Huai B. He2, Richard Parker1, and Brian W. Christman1

1 Division of Pulmonary, Allergy, and Critical Care Medicine and 2 Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2650

Prostacyclin (or epoprostenol), an arachidonic acid metabolite, is an effective treatment for patients with primary pulmonary hypertension. Interruption of chronic prostacyclin infusion can result in recurrent symptoms of dyspnea and fatigue. The etiology of this phenomenon is unknown. We hypothesized that sympathoadrenal activation could lead to increased vascular tone after abrupt termination of the infusion. To evaluate this effect, we monitored six chronically instrumented, awake sheep during and after infusion of prostacyclin. Prostacyclin decreased mean arterial pressure (MAP) by 14% and increased cardiac output by 33%. After the infusion ceased, MAP rebounded 23% above baseline, and cardiac output decreased by 28% from peak values within 10 min. We were unable to demonstrate an increase in norepinephrine levels after cessation of prostacyclin, nor did alpha -adrenergic blockade affect postinfusion hemodynamics. However, plasma renin activity increased >10-fold at peak infusion and remained elevated for up to 2 h after discontinuation of prostacyclin. Coinfusion of the angiotensin II-receptor antagonist L-158,809 resulted in complete abrogation of the postcessation rise in MAP. We conclude that renin-angiotensin system activation is primarily responsible for systemic hypertension occurring after abrupt cessation of prostacyclin infusion in sheep and that angiotensin II receptor blockade prevents this response. Our data do not support a role for sympathetic nervous system activation in the systemic pressor response after prostacyclin infusion.

prostaglandin I2; epoprostenol; pulmonary hypertension; renin; norepinephrine


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S. Rich and V. V. McLaughlin
The effects of chronic prostacyclin therapy on cardiac output and symptoms in primary pulmonary hypertension
J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1184 - 1187.
[Abstract] [Full Text] [PDF]




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