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1 Division of Pulmonary,
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
-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
This article has been cited by other articles:
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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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