Does long-term ACE inhibitor treatment restore the renal hemodynamic response to L-arginine infusion in patients with essential hypertension?
Long-term ACE inhibitor treatment, but not other antihypertensive therapies, restores the renal vasodilator response to L-arginine in essential hypertension, suggesting a specific restorative effect on the renal nitric oxide pathway.
We assessed the renal hemodynamic response to L-arginine infusion (30 g within 60 minutes) in normotensive subjects, patients with never-treated essential hypertension, and hypertensive patients controlled by long-term (more than 2 years) treatment with or without an angiotensin-converting enzyme inhibitor. The renal vasodilator response to L-arginine observed in normotensive subjects (15 +/- 4% increase in effective renal plasma flow) was abolished in untreated hypertensive patients and restored only in the group treated by angiotensin-converting enzyme inhibition. In the whole population a positive correlation between the change in effective renal plasma flow and the change in urinary cGMP was obtained. It is suggested that abnormalities of the renal nitric oxide pathway not corrected by increased availability of L-arginine and reversible only on long-term treatment by angiotensin-converting enzyme inhibition may underlie the abnormal renal resistance observed in essential hypertension.
Mimran et al. (Fri,) studied this question.
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