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(Hypertension. 1999;34:1293.)
© 1999 American Heart Association, Inc.

Scientific Contributions

Effects of the Nonpeptide V₁ Vasopressin Receptor Antagonist SR49059 in Hypertensive Patients

Marc Thibonnier; Ahmad Kilani; Mahboob Rahman; Tina Pilumeli DiBlasi; Kelly Warner; Michael C. Smith; Anne Françoise Leenhardt; Rémi Brouard

From the Department of Medicine (M.T., A.K., M.R., T.P.D., K.W., M.C.S.), Case Western Reserve University School of Medicine and University Hospitals, Cleveland, Ohio; and Sanofi Recherche (A.F.L., R.B.), Montpellier, France.

Correspondence to Dr Marc Thibonnier, Room BRB431, Division of Clinical and Molecular Endocrinology, Department of Medicine, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106-4951. E-mail mxt10{at}po.cwru.edu

Abstract—We assessed the clinical and pharmacological profile of the orally active V₁ vascular vasopressin (AVP) receptor nonpeptide antagonist SR49059 (SR) during the osmotic stimulation of AVP release in hypertensive patients. In a double-blind crossover-versus-placebo study, 24 untreated stage I or II essential hypertensive patients (12 whites and 12 blacks) received a single 300 mg oral dose of SR 2 hours before the stimulation of AVP secretion with a 5% hypertonic saline infusion. Hemodynamic, humoral, and hormonal parameters were monitored for up to 28 hours after drug administration. SR did not alter blood pressure or heart rate before the saline infusion and did not reduce the blood pressure increment induced by the hypertonic saline infusion. However, the blood pressure peak at the end of the hypertonic saline infusion was slightly lower in the presence of SR (P=0.04). Heart rate was significantly faster between 4 and 6 hours after SR administration (P=0.02). The rise in plasma sodium and osmolality triggered by the saline infusion was not modified by SR, but AVP release was slightly greater in the presence of SR (P<0.0003). AVP-induced aggregation of blood platelets in vitro was significantly reduced by SR, with a peak effect 2 hours after drug administration that coincided with the SR peak plasma concentration. Plasma renin activity and aldosterone before and after the saline infusion were not modified by SR. Urine volume and osmolality were not altered by SR administration. SR effects were similar in the 2 ethnic groups as well as in salt-sensitive versus salt-resistant patients. In a situation of AVP osmotic release and volume expansion in hypertensive patients, a single oral dose of the V₁ vascular AVP receptor nonpeptide antagonist SR49059, which is able to block AVP-induced platelet aggregation, exerts a transient vasodilation effect that is not associated with a sustained blood pressure reduction. SR49059 is a pure V₁ vascular receptor antagonist that is devoid of V₂ renal receptor actions.

Key Words: vasopressins • nonpeptide antagonist • vasopressins • hypertension, essential • osmoregulation

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