Enalapril did not significantly increase overall urinary NTproBNP excretion versus placebo, though a subgroup with increased sodium excretion showed higher NTproBNP excretion (p<0.05).
RCT (n=10)
Double-blind
Crossover
Does enalapril modulate the renal excretion of NTproBNP in healthy male volunteers?
Enalapril may modify the renal excretion of NTproBNP in healthy subjects, particularly those showing an increase in sodium excretion, though the exact mechanism remains unclear.
AIMS: This study was designed to test if the renal excretion of the N-terminal prohormone of the B-type natriuretic peptide (NTproBNP) is modulated by angiotensin-converting enzyme inhibition (ACE-I). METHODS: Following 7 days on a sodium-enriched diet and an induction period of 4 days with incremental dosages of enalapril (2.5, 5, 7.5, 10 mg) or placebo, 10 healthy subjects underwent crossover and double-blind treatment with 20 mg enalapril sodium or placebo at 8:00 h. After 4 h (at 12:00 h), 20 ml.kg(-1) NaCl 0.9% was infused over 60 min. Hemodynamics were determined and blood and urine were sampled at 8:00, 12:00, 13:00, 14:00, 16:00, and 18:00 h. Angiotensin II (AII), NTproANP, and NTproBNP were determined by radio- and electrochemiluminescence immunoassays. RESULTS: In the whole group, ACE-I led to a lower arterial blood pressure during the fourth day of induction and during the time from 8:00 to 16:00 h, a decrease in AII levels from 8:00 to 14:00 h (p < 0.05), and to a higher cumulative urine output (p < 0.05) in comparison with control. Neither cumulative sodium nor urinary NTproBNP/creatinine excretion were significantly increased after ACE-I. However, a subgroup of 6 volunteers - showing an increase in sodium excretion after ACE-I - also demonstrated lower AII levels at 13:00 h, a higher cumulative urine flow, and a higher urinary NTproBNP/creatinine excretion in comparison with control (all: p < 0.05). CONCLUSIONS: This suggests that the renal excretion of NTproBNP is modified by enalapril. However, it remains to be determined if this is a direct effect of ACE-I, the decrease in arterial blood pressure, or other potentially confounding variables like bradykinin or endopeptidase activity.
Heringlake et al. (Sun,) conducted a rct in Healthy (n=10). Enalapril vs. Placebo was evaluated on Urinary NTproBNP/creatinine excretion. Enalapril did not significantly increase overall urinary NTproBNP excretion versus placebo, though a subgroup with increased sodium excretion showed higher NTproBNP excretion (p<0.05).