(Hypertension. 1999;34:964-968.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
From the Department of Pharmacology, Monash University, Clayton, Victoria, Australia.
Correspondence to Dr Robert Widdop, Department of Pharmacology, Monash University, Clayton, Victoria 3168, Australia. E-mail robert.widdop{at}med.monash.edu.au
| Abstract |
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Key Words: angiotensin bradykinin angiotensin-converting enzyme inhibitors rats, inbred SHR blood pressure
| Introduction |
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The well-documented antihypertensive and cardioprotective effects of ACE inhibitors are thought to occur through the inhibition of circulating or tissue Ang II formation and the prevention of bradykinin degradation.11 Interestingly, ACE inhibitors elicit 5- to 50-fold increases in plasma and tissue levels of Ang-(17) in both SHR and humans.12 13 Consequently, it has been postulated that Ang-(17) may contribute to the blood pressurelowering effect of ACE inhibition.3 Therefore, it is important for other researchers to confirm some of these interesting effects of Ang-(17). An interaction between Ang-(17) and bradykinin may contribute to the antihypertensive effect of ACE inhibitors, and a direct vasodilator effect of Ang-(17) may exist in vivo. Therefore, in this study, we attempted to confirm whether Ang-(17) (1) potentiates the hypotensive effect of bradykinin in both normotensive and hypertensive rats and (2) causes direct depressor activity after long-term treatment in SHR. In so doing, we also used a dose of A-779 that attenuated the depressor effect of Ang-(17) (see Results). Consequently, as our third aim, we determined if Ang-(17) contributes to the blood pressurelowering effects of ACE inhibitors by determining whether long-term treatment with A-779 interferes with the antihypertensive effect of the ACE inhibitor perindopril.
| Methods |
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Short-Term Studies
In WKY rats (n=5) and SHR (n=11), a control dose-response curve
to bolus injections of bradykinin (0.125, 0.25, 0.5, 1, and 2 µg IV)
was constructed. Thereafter, a 2-hour intravenous infusion
of either saline (0.35 mL/hr) or Ang-(17) (5 pmol/min) was begun, and
the bradykinin dose-response curves were repeated at 30 and 90 minutes
during infusion. Analogous experiments were performed in SHR during the
infusion of saline or 5, 50, or 500 pmol/min Ang-(17) on 4 separate
days. At least 5 minutes was allowed between each dose of bradykinin
because that was the time required for mean arterial
pressure (MAP) and heart rate (HR) to return to baseline levels.
Long-Term Ang-(17) Infusions
In 4 separate groups of SHR, MAP and HR were recorded at
least 2 days before starting a 7-day intravenous infusion
of (1) saline (5 µL/hr; n=11), (2) Ang-(17) (24 µg ·
kg-1 · h-1; n=12),
(3) the putative Ang-(17) antagonist A-779 (24 µg
· kg-1 · h-1,
n=4), or (4) Ang-(17) and A-779 (both at 24 µg ·
kg-1 · h-1; n=8).
The dose of Ang-(17) was chosen on the basis of a previous
study.8 Dual infusions were carried out using a
double-channel swivel system (Instech Laboratories). All rats received
fresh drug daily, and MAP and HR were recorded for at least 1 hour
per day throughout the 7-day treatment periods. Ang-(17) and A-779
were purchased from Bachem.
Perindopril Treatment
To determine the potential contribution of Ang-(17) to the
antihypertensive effect of an ACE inhibitor in SHR, both
MAP and HR were recorded at least 2 days before starting treatment
with perindopril (0.3 mg · kg-1 ·
day-1 for 7 days; given in drinking water),
either alone (n=6) or at the same time as receiving an
intravenous infusion of A-779 (24 µg ·
kg-1 · h-1; n=8).
MAP and HR were recorded for at least 1 hour each day throughout
the 7-day treatment period, and rats received fresh drug daily.
Perindopril was a gift from Servier (Melbourne, Australia).
Statistical Analysis
A 1-way ANOVA with repeated measures was used for comparisons
within treatment groups for MAP and HR responses evoked by bradykinin
in the short-term studies and the changes in basal MAP and HR values
over time in the long-term studies. Comparisons of basal MAP and HR
values between treatment groups in the long-term studies were
analyzed using a 2-way ANOVA with repeated measures. Values are
expressed as mean±SEM. Statistical significance was
P<0.05.
| Results |
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Long-Term Studies
In SHR, saline did not alter MAP or HR over the 7-day infusion
period (Figure 4). Similarly, the
selective Ang-(17) receptor antagonist A-779 did not
alter MAP significantly over the infusion period; it did tend to
decrease HR, although this effect was only significant compared with
the saline-treated group on day 6 (P<0.05) (Figure 4). When Ang-(17) was infused long-term in SHR, a progressive
decrease in MAP occurred; this was significant compared with baseline
values on days 4 and 5 (-21±8 and -21±7 mm Hg, respectively;
P<0.05; Figure 5). This
depressor response also differed from the change in MAP in the
saline-treated group at this time (days 4 and 5, -6±6 and -1±5
mm Hg, respectively). In contrast, when Ang-(17) was coinfused with
A-779, resting MAP was not significantly different from its own
baseline or to that observed during saline infusion, although this
Ang-(17)/A-779 combination was on the borderline of significance
(P=0.07) when compared with Ang-(17) treatment alone
(Figure 5). Ang-(17) alone caused minimal changes in HR,
except for a small bradycardia, when compared with saline-treated SHR
on day 5 (P<0.05) (Figure 5). Gradual
tachycardia developed with the Ang-(17)/A-779 infusion
compared with either the saline-treated (P<0.05, day 7) or
Ang-(17) alone groups (P<0.05, days 5 to 7) (Figure 5).
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In separate SHR, treatment with perindopril alone caused an immediate
decrease in MAP of
35 mm Hg that was sustained throughout the
7-day treatment period; HR tended to decrease over this time. However,
neither the MAP nor HR effects observed during perindopril treatment
were significantly altered by cotreatment with A-779 (Figure 6).
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| Discussion |
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Short-term infusion of Ang-(17) did not alter baseline MAP or HR at any of the doses used in either SHR or WKY rats. This is consistent with previous studies showing that Ang-(17) itself is a weak vasoactive peptide.3 Short-term infusion of Ang-(17) also failed to potentiate bradykinin-induced hypotension in WKY rats, although this dose was previously reported to augment bradykinin responses in conscious rats.9 Similarly, no significant difference existed in the dose-related hypotension produced by bradykinin after the infusion of Ang-(17) at the same or 10- to 100-fold higher doses in SHR. No obvious reasons exist regarding our negative findings, which contrast with those of 1 other group.9 10 Strain differences in normotensive rats may be involved, although this effect does not explain the opposite findings using SHR. Ang-(17) was obtained from a commercial supplier (Bachem), whereas this peptide was synthesized in-house in previous studies.9 10 However, we also used Ang-(17) from another source (American Peptide Co) and found identical results.
When infused over a 7-day period, Ang-(17) significantly reduced blood pressure in SHR on days 4 and 5 of the infusion, although this effect was not sustained. This blood pressurelowering effect of Ang-(17) is consistent with the results of Benter et al,8 who reported a more rapid decline in blood pressure (by day 2) and a gradual return to pretreatment levels by day 7. In this earlier study, osmotic minipumps were used to deliver the peptide. In the present study, we deliberately chose to infuse a fresh solution daily to avoid any confounding problems such as pump failure and/or degradation of peptide. However, given that both studies noted a depressor response that was not maintained, it is likely that other compensatory vasoconstrictor mechanisms were activated to offset the antihypertensive action of Ang-(17).
Ang-(17) is thought to act via an Ang (AT) receptor that is distinct from either AT1 or AT2 receptors.3 4 5 Moreover, the mechanisms by which Ang-(17) lowers MAP are likely to involve prostaglandins and/or nitric oxide.4 5 Importantly, we have shown for the first time that Ang-(17)-induced hypotension was attenuated with respect to predrug baseline values when coinfused with the selective Ang-(17) receptor antagonist A-779. The attenuation of the hypotensive effect of Ang-(17) was slightly less evident when compared with Ang-(17) alone, although the same analysis did reveal a significant difference in the HR effects. Moreover, the fact that the combination was similar to saline treatment would also argue for the lack of effect of Ang-(17) when combined with the antagonist. Indeed, several in vitro and in vivo studies have demonstrated an inhibitory effect of this compound when tested against Ang-(17),10 14 15 and thus our results are consistent with those studies.
The fact that reports have shown that plasma and tissue levels of Ang-(17) are elevated after ACE inhibition in both SHR and humans12 13 and the finding that similarities exist between the antihypertensive response produced by long-term Ang-(17) treatment and that of ACE inhibitors8 have lead some to think that this heptapeptide may contribute to the blood pressurelowering effect of ACE inhibitors.3 Consequently, we determined whether Ang-(17) actually contributes to ACE inhibition by infusing the Ang-(17) selective antagonist A-779 during treatment with the ACE inhibitor perindopril. Importantly, at the dose used, A-779 attenuated the depressor effect of Ang-(17), although it did not significantly attenuate the antihypertensive effect of perindopril. Thus, these novel results indicate a lack of involvement of Ang-(17) in the effect of perindopril. It is possible that a higher dose of A-779, which could abolish the effects of Ang-(17), may attenuate the effects of ACE inhibition; however, due to cost considerations, this experiment could not be undertaken. Nevertheless, several points would argue against this possibility. First, the dose of A-779 used in the present study was effective against Ang-(17), and second, the depressor effect of Ang-(17) per se waned, despite continual infusion of the peptide (current study and reference 8).
However, our results are in direct contrast to recent studies which showed that both monoclonal antibodies against Ang-(17) and neutral endopeptidase inhibitors, given short-term, could partially reverse the antihypertensive effect of 8-day treatment with combined ACE inhibition and AT1 receptor blockade.16 17 Interestingly, the Ang-(17) antibody evoked a small pressor response in the treated SHR; however, this effect had waned by at least one-third during the 15-minute infusion of neutralizing antibody.16 In contrast, the pharmacodynamics of the pressor responses to the NEP inhibitors were quite different: maximum (albeit partial) reversal of blood pressure was achieved at the end of the infusion period (10 to 15 minutes), which suggests that differences exist between the mechanisms of action of these inhibitors of Ang-(17).17 Moreover, the short-term effects of blockade of Ang-(17) do not necessarily predict the long-term effects of such inhibition. Indeed, our results using long-term administration of A-779 to interfere with Ang-(17) imply a negligible role for this peptide in the antihypertensive effect of ACE inhibitors when tested under long-term conditions.
In summary, we have shown that Ang-(17) does not possess bradykinin-potentiating activity in either SHR or WKY rats short-term, but it does cause a slowly developing depressor response, which was not sustained, when infused long-term in SHR. However, at a dose that inhibited Ang- (17), A-779 failed to alter the cardiovascular effects of perindopril. Therefore, although a number of previous studies have implicated Ang-(17) as being involved in cardiovascular regulation, our results do not support the premise that Ang-(17) plays a key role in blood pressure regulation or as a component of the antihypertensive effect of ACE inhibitors.
| Acknowledgments |
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Received May 10, 1999; first decision June 15, 1999; accepted July 14, 1999.
| References |
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