Angiotensin-induced myocardial necrosis and renal failure in the rabbit: distribution of lesions and severity in relation to plasma angiotensin II concentration and arterial pressure

Long-term effects of early overnutrition in the heart of male adult rats: role of the renin-angiotensin system

To analyze the long-term effects of early overfeeding on the heart and coronary circulation, the effect of ischemia-reperfusion (I/R) and the role of the renin-angiotensin system (RAS) was studied in isolated hearts from control and overfed rats during lactation. On the day of birth litters were adjusted to twelve pups per mother (controls) or to three pups per mother (overfed). At 5 months of age, the rats from reduced litters showed higher body weight and body fat than the controls. The hearts from these rats were perfused in a Langendorff system and subjected to 30 min of ischemia followed by 15 min of reperfusion (I/R). The myocardial contractility (dP/dt) and the coronary vasoconstriction to angiotensin II were lower, and the expression of the apoptotic marker was higher, in the hearts from overfed rats compared to controls. I/R reduced the myocardial contractily, the coronary vasoconstriction to angiotensin II and the vasodilatation to bradykinin, and increased the expression of (pro)renin receptor and of apoptotic and antiapoptotic markers, in both experimental groups. I/R also increased the expression of angiotensinogen in control but not in overfed rats. In summary, the results of this study suggest that early overnutrition induces reduced activity of the RAS and impairment of myocardial and coronary function in adult life, due to increased apoptosis. Ischemia-reperfusion produced myocardial and coronary impairment and apoptosis, which may be related to activation of RAS in control but not in overfed rats, and there may be protective mechanisms in both experimental groups.

Angiotensin-converting enzyme inhibition reduces lipid deposits in myocardium and improves left ventricular function of obese zucker rats

OBJECTIVE

Alterations in the renin angiotensin system, cardiac lipotoxicity, and left ventricular (LV) dysfunction have been reported in obese rats. The present study examined whether angiotensin-converting enzyme inhibition could ameliorate lipid deposition and ventricular function in the myocardium of obese Zucker rats (OZRs).

RESEARCH METHODS AND PROCEDURES

For 6 months, rats were treated as follows: Group (G) 1, OZR, no treatment; G2, OZR + ramipril (R); G3, OZR + amlodipine (AML); and G4, lean Zucker rats. LV function was assessed by echocardiogram and lipid deposits in cardiomyocytes (LDCM) by light microscopy using Oil red O.

RESULTS

At the end of the experiment, both OZR + R and OZR + AML groups presented similar reduction in blood pressure in comparison with untreated OZR (p < 0.01). OZR with R presented lower insulin-to-glucose ratio and lower serum triglycerides and cholesterol when compared with both untreated OZR and OZR with AML (p < 0.01). Fractional shortening by echocardiogram was as follows: G1, 25.4 +/- 3.8 (vs. G2 and G4, p < 0.05); G2, 37.2 +/- 2.4; G3, 29.3 +/- 4.4 (vs. G2 and G4, p < 0.05); and G4, 40.8 +/- 2.3. Percentage LDCM was as follows: G1, 12.4 +/- 2.7 (vs. G2 and G4, p < 0.05); G2, 0.8 +/- 0.2; G3, 11.1 +/- 2.1 (vs. G2 and G4, p < 0.05); and G4, 0.1 +/- 0.1. There was a negative correlation between fractional shortening and LDCM percentage in OZR (r = -0.93) and in OZR + AML (r = -0.87).

DISCUSSION

AML reduced blood pressure significantly; however, it failed to modify both metabolic parameters and LDCM. In contrast, R showed a substantial reduction in LDCM, together with LV function preservation.

Cardiovascular protective role of a low-dose antihypertensive combination in obese Zucker rats

OBJECTIVE

Obesity, non-insulin-dependent diabetes mellitus (NIDDM) and hypertension are leading causes associated with increased cardiovascular morbidity and mortality. In modern times, the combined first line antihypertensive therapy with at least two drugs with a different mechanism of action to achieve a better blood pressure control, is increasing in acceptance worldwide. The aim of the present study was to determine possible beneficial effects of the low-dose combination (LDC) of an angiotensin-converting enzyme (ACE) inhibitor, perindopril (PER), and the diuretic indapamide (IND), regarding myocardial and vessels protection in an animal model of hypertension, obesity and NIDDM, such as the obese Zucker rat (OZR), and control lean Zucker rats (LZR).

DESIGN

Ten-week-old male OZR (fa/fa) and LZR (Fa/fa) were used in this study. OZR group (G1, n=8), OZR with LDC group (G2, n=8); LZR group (G3, n=8) and LZR with LDC group (G4, n=8). During 6 months, G2 and G4 received a daily dose of 1 mg/kg combination of 0.76 mg/kg PER + 0.24 mg/kg IND, (ratio of doses 0.32), by gavage, and G1 and G3 received an equal volume of vehicle throughout the experiment. In order to evaluate cardiac dimensions and left ventricular mass (LVM) transthoracic echocardiograms were performed, at baseline and at the end of the experiment. Urine and blood samples for biochemical determination were obtained. After 6 months of treatment all rats were sacrificed, hearts were harvested for light microscopy (LM), high-resolution light microscopy (HRLM), immunohistochemistry including monoclonal antibodies against transforming growth factor beta (TGFbeta1) and anti-collagen type I (COL I) and type III (COL III) and electron microscopy (EM) studies.

RESULTS

At the end of the study OZR treated with LDC presented: (1) lower blood pressure (128.9 +/- 4 versus 150.3 +/- 3.6 mmHg, P< 0.05); (2) smaller cardiac dimensions (P< 0.01); (3) lower LVM/100 g body weight (0.17 +/- 0.02 versus 0.30 +/- 0.05, P< 0.01); (4) higher fractional shortening (34.5 +/- 3.2 versus 23.3 +/- 5.9%, P< 0.01) than OZR untreated. Moreover, OZR that received LDC showed higher: (1) myocyte density (48 +/- 1.5 versus 20 +/- 2.5 myocytes/area, P< 0.01); (2) capillary density (30.5 +/- 3.1 versus 9.5 +/- 1.6 capillaries/area, P<0.01); (3) myofilament thickness (12.05 +/- 0.27 versus 9.83 +/- 0.39 nm, P<0.01); and lower amounts of: (1) TGFbeta1 in myocytes (P< 0.01), interstitium (P< 0.01) and vessel wall (P< 0.05); (2) COL I and COL III (P< 0.01), and COL I /COL III ratio (P< 0.01), compared with untreated OZR. Finally, OZR-treated with LDC showed not only unsubstantial modification in carbohydrate and lipid metabolism when compared with untreated OZR, but also an improvement in insulin/glucose ratio (P< 0.05).

CONCLUSION

These results suggest that LDC of PER + IND can control cardiovascular damage in OZR providing an additional help in the metabolic scenario likewise.

Dietary salt and hypertension: a scientific issue or a matter of faith?

Many workers have an overly simplistic view of the relationship between salt intake and hypertension. This article attempts a critical evaluation of some of the evidence.

Experimental and clinical evidence that angiotensin II is an independent risk factor for cardiovascular disease

The role of the renin-angiotensin system in the regulation of normal blood pressure and in the pathogenesis of hypertension has long been appreciated. Angiotensin II (Ang II) was originally thought to only influence blood pressure, but the results of many preclinical and clinical studies now suggest that Ang II has an important and distinct role in other cardiovascular pathologies. Drugs that interfere with the renin-angiotensin system, such as angiotensin-converting enzyme (ACE) inhibitors, are now widely accepted for the treatment of chronic renal failure and heart failure. Recent studies have shown that Ang II acts directly on the myocardium to cause ventricular hypertrophy, a response that can be prevented or reversed by selective Ang II type 1 receptor antagonists. The utility of angiotensin receptor antagonists in the treatment of chronic renal failure has been demonstrated, and the results of ongoing clinical trials can be expected to prove their benefit in other cardiovascular pathologies.

Angiotensin II does not induce apoptosis but rather prevents apoptosis in cardiomyocytes

The ability of angiotensin II (ang II) to produce apoptosis is controversial. Cardiomyocytes, isolated from 7-day embryonic chick hearts and maintained in culture for 72 h, were treated with ang II. There was no evidence of ang II-induced apoptosis consistently demonstrated by six different techniques: electrophoretic separation of fragmented DNA, staining with TUNEL, enzyme-linked immunosorbent assay specific for fragmented DNA, dual staining of cells with fluorescein diacetate and propidium iodide with analysis by flow cytometry, staining of nuclei with propidium iodide and cell microscopy. In contrast, apoptosis was readily induced by camptothecin or staurosporine or serum deprivation. The absence of ang II-induced cell death was also demonstrated in neonatal mouse cardiomyocytes in culture. We further sought to answer the question whether ang II Type 1 receptor blockade by antagonizing the potential beneficial effects mediated through this receptor and producing more ang II binding to the ang II Type 2 receptors, would lead to cardiac apoptosis. There was no evidence of ang II-induced apoptosis in the presence of the ang II Type 1 receptor antagonist losartan in embryonic chick cardiomyocytes. Rather ang II prevented serum deprivation-induced apoptosis. In summary, in these cardiomyocytes ang II does not induce but rather prevents apoptosis.

Effects of the AT1-selective angiotensin II antagonist, telmisartan, on hemodynamics and ventricular function after cardiopulmonary resuscitation in pigs

The purpose of this study was to investigate the effects of the angiotensin II (ANG II) antagonist, telmisartan, on hemodynamics, myocardial function and myocardial blood flow during the postresuscitation phase in a porcine model of CPR and to compare these to saline. After 4 min of ventricular fibrillation and 5 min of closed-chest CPR, defibrillation was performed in 16 domestic pigs to restore spontaneous circulation (ROSC). Ten minutes after ROSC, animals were allocated to receive either the ANG II antagonist, telmisartan, at a dose of 1 mg/kg (n = 8) or saline (n = 8). Hemodynamics, myocardial function and myocardial blood flow were measured prearrest and at 5, 30, 90 and 240 min after ROSC. Using a Swan-Ganz catheter with a fast responding-thermistor and a micromanometer tipped catheter, right ventricular end-diastolic and end-systolic volume, right ventricular ejection fraction, left ventricular contractility were 67 +/- 6 ml (mean +/- S.E.M.), 42 +/- 4 ml, 38 +/- 2%, 2036 +/- 77 mmHg/s in the telmisartan group and 82 +/- 2 ml (P < 0.05), 59 +/- 3 ml (P < 0.01), 28 +/- 2% (P < 0.01), 1596 +/- 82 mmHg/s (P < 0.01) in the control group, at 240 min after ROSC. No significant differences in mean aortic and pulmonary artery pressure, cardiac index or myocardial blood flow between the two groups were found. We conclude that the ANG II antagonist telmisartan administered during the postresuscitation phase in pigs increases myocardial contractility without changing cardiac index, systemic vascular resistance, pulmonary vascular resistance, or myocardial perfusion.

Hypertensive arteriolar necrosis revisited

Arteriolar necrosis is the histopathological hallmark of malignant hypertension. In the period from 1940 to 1980, intensive studies of the pathogenesis of hypertensive fibrinoid necrosis were carried out. From studies of mesenteric vessels in animals with experimental hypertension it was discovered that arteriolar necrosis is preceded by an abnormal vascular reaction pattern consisting of alternating constriction and localized dilatations. The development of the abnormal reaction pattern is followed by endothelial hyperpermeability resulting in transsudation of plasma and macromolecules into the wall of the arteriole. The hyperpermeability, and, in turn, arteriolar necrosis, is exclusively found in the dilated segments of the vessel. The abnormal vascular reaction pattern can be induced experimentally by various techniques such as infusion of angiotensin II or stimulation of perivascular nerves, and it can be demonstrated in all target organs. Since 1980 a remarkable falling-off in the research on the pathogenesis of hypertensive arteriolar necrosis has been noted. Recent studies in this area utilizing current knowledge and major advances in microvascular research methods are very few in number. As of today, the chain of pathogenetic processes leading eventually to the all-important lesion of arteriolar fibrinoid necrosis remains poorly understood.

Heart failure: lessons learned over the past 25 years

Over the past 25 years, a great deal has been learned about the pathophysiology and management of heart failure--a major health problem whose prevalence and incidence have not declined, unlike other cardiovascular disorders. Several of these lessons are reviewed herein. However, despite these advances, important issues remain to challenge both the practicing physician and the research scientist.

Expanding the paradigm of the renin-angiotensin system and angiotensin-converting enzyme inhibitors

The renin-angiotensin system acts systemically and locally to influence vascular tone, blood volume, myocardial contractility, thromboresistance, and tissue responses to injury. ACE inhibitors have assumed a vital role in the treatment of patients with ventricular dysfunction, including those who have sustained one or more myocardial infarctions. The greatest benefits appear over time and not unexpectedly are most pronounced in cases of moderate to severe reduction in left ventricular performance. Emerging evidence suggests that the paradigm for ACE inhibitor use will expand even further, opening new doors for patient care.

Fibrosis and myocardial ACE: possible substrate and independence from circulating angiotensin II

In order to determine the relation between myocardial fibrosis and (1) angiotensin converting enzyme (ACE) binding density, (2) receptor binding of ACE-related peptides, angiotensin II (AngII) and bradykinin (BK), and (3) the regulation of myocardial ACE by circulating Ang II, we used in vitro quantitative autoradiography to localize and assess ACE ([125I]351A), AngII receptor (125I[Sar1, IIe8]AngII), and BK receptor ([125I]Tyr8) binding densities in the rat myocardium. The experimental groups were (1) AngII (9 micrograms/h subcutaneously) or aldosterone (0.75 microgram/h subcutaneously in uninephrectomized rats on a high-sodium diet) administered by implanted minipump to chronically increase or decrease circulating AngII, respectively, (2) unoperated, untreated age- and sex-matched control rats, and (3) age- and sex-matched uninephrectomized control rats on a high-sodium diet. In the same heart studied at 2, 4, and 6 weeks of hormone treatment, serial sections were assessed for myocardial (hematoxylin and eosin) and fibrillar collagen (picrosirius red) morphology. The authors found that (1) marked ACE binding was coincident with sites of fibrous tissue that appeared in both ventricles as either a perivascular fibrosis of intramyocardial coronary arterioles or microscopic scarring in response to AngII or aldosterone infusion, (2) ACE binding was independent of circulating AngII, (3) BK, not AngII, receptor binding density was markedly increased at fibrous tissue sites, and (4) high-density ACE and BK receptor binding were anatomically coincident. Thus, in these experimental models, ACE is related to fibrous tissue formation where it may use BK, not angiotensin I, as a substrate, and its binding density is independent of circulating AngII.

Relationship between hemostatic abnormalities and neuroendocrine activity in heart failure

Thromboembolism is an important complication of heart failure. To test the hypothesis that heart failure may be associated with hemostatic dysfunction, we studied hemostatic function in 21 patients with stable chronic heart failure and related these measures to the severity of heart failure as assessed by clinical evaluation, neuroendocrine activation, radionuclide ventriculography, and cardiopulmonary exercise testing. Plasma and blood viscosity were elevated; all patients showed evidence of platelet activation, and many had elevated plasma concentrations of fibrinopeptide A, D-dimer, and von Willebrand factor. The plasma concentrations of these variables were poorly interrelated and related poorly to the severity of heart failure. Plasma concentrations of angiotensin II and endothelin were correlated, and the latter was also correlated with the plasma concentration of von Willebrand factor. Patients with chronic heart failure have hemostatic abnormalities that may predispose them to thromboembolic events and may be in part due to neuroendocrine activation.

Angiotensin-converting enzyme inhibitors, left ventricular dysfunction, and early heart failure

A study was undertaken to examine the effects of the angiotensin-converting enzyme inhibitor lisinopril on exercise performance in 18 patients with major impairment of left ventricular systolic function. The study was a randomized, double-blind, crossover design, and patients received treatment with either once-daily lisinopril (2.5-10 mg) or placebo for a period of 6 weeks. A total of 15 patients completed the study. Compared with placebo, lisinopril had no significant effect on supine or standing blood pressure or heart rate. Although lisinopril had no effect on exercise duration during a low-intensity exercise protocol, in patients undergoing a high-intensity exercise protocol, there was a trend toward improved exercise time and peak oxygen consumption improved significantly. In addition, treatment with lisinopril resulted in an increase in renal blood flow and a reduction in glomerular filtration rate. Moreover, administration of once-daily lisinopril 10 mg resulted in a decrease in plasma concentrations of angiotensin II, aldosterone, and atrial natriuretic peptide, and an increase in plasma concentrations of active renin.

Importance of RAA system and the treatment of patients with ACE inhibition after myocardial infarction

There is activation of the renin angiotensin system after both complicated and uncomplicated myocardial infarction. Angiotensin II increases myocardial oxygen consumption whilst reducing coronary flow and is also directly toxic to the myocardium. Angiotensin converting enzyme inhibitors produce beneficial haemodynamic and neuroendocrine changes in patients with acute left ventricular failure, and may have a role in selected patients with cardiogenic shock. There is evidence to suggest that they might prevent the development of late cardiac failure by limiting the extent of post infarction ventricular dilation. Further research is necessary to define their role in the treatment of acute myocardial infarction.

Effect of enalapril on ventricular arrhythmias in congestive heart failure

Twenty-four-hour Holter electrocardiographic recordings were used to measure the effects of a converting-enzyme inhibitor, enalapril, given for 12 weeks, on the frequency of cardiac arrhythmias in 10 patients with congestive heart failure (New York Heart Association functional class II to III) receiving maintenance therapy with digoxin and furosemide. Nine patients were given placebo, and both study groups were conducted in a double-blind, parallel manner. The placebo group had no change in the frequency of arrhythmias, whereas enalapril-treated patients showed a significant decrease in the frequency of premature ventricular complexes, ventricular couplets and ventricular tachycardia. A minor, nonsignificant reduction in atrial premature complexes was seen in patients who received enalapril. Compared with placebo patients, those who received enalapril had an increase in plasma potassium levels of 0.33 mmol/liter, a decrease in plasma digoxin, and decreases in pulmonary artery wedge, mean pulmonary artery and right atrial pressures. However, none of these indexes were correlated with the concomitant decline in cardiac arrhythmias. It is concluded that enalapril reduces the frequency of ventricular arrhythmias in congestive heart failure, although the underlying mechanisms are not known.