Haemodynamic and hormonal effects of adrenomedullin in patients with pulmonary hypertension

Abstract

Objective: To investigate whether infusion of adrenomedullin, a potent vasorelaxant peptide, has beneficial haemodynamic and hormonal effects in patients with pulmonary hypertension.

Patients and design: The haemodynamic and hormonal responses to intravenous infusion of adrenomedullin (0.05 microgram/kg/min) or placebo were examined in 13 patients with precapillary pulmonary hypertension.

Results: Infusion of adrenomedullin produced a 44% increase in cardiac index (mean (SD) 1.8 (0.2) to 2.6 (0.3) l/min/m(2), p < 0. 05) and a 32% decrease in pulmonary vascular resistance (19.7 (1.4) to 13.4 (1.3) units, p < 0.05), with a 4% reduction in mean pulmonary arterial pressure (62 (4) to 59 (4) mm Hg, NS). Adrenomedullin also decreased mean systemic arterial pressure (81 (3) to 72 (4) mm Hg, p < 0.05) and increased heart rate (73 (4) to 79 (4) beats/min, p < 0.05). Adrenomedullin decreased plasma aldosterone (9.8 (2.5) to 7.1 (1.5) ng/dl, p < 0.05) without significant changes in plasma renin activity. Plasma atrial and brain natriuretic peptides tended to decrease with adrenomedullin, although these changes did not reach significance. The haemodynamic and hormonal variables remained unchanged during placebo infusion.

Conclusions: Intravenous adrenomedullin has beneficial haemodynamic and hormonal effects in patients with precapillary pulmonary hypertension.

Figure 1

Changes in mean pulmonary arterial pressure (mPAP), cardiac index (CI), pulmonary vascular resistance (PVR), and systemic vascular resistance (SVR) during the intravenous infusion of adrenomedullin (•) or placebo (◯) in patients with pulmonary hypertension. Data are means, error bars = SEM. *p < 0.05 v value at time 0; †p < 0.05 v placebo group.

Figure 2

Changes in plasma adrenomedullin, cyclic adenosine 3',5'-monophosphate (cAMP), renin activity, and aldosterone during intravenous infusion of adrenomedullin (•) or placebo (◯) in patients with pulmonary hypertension. Data are means, error bars = SEM. AM, adrenomedullin. *p < 0.05 v before; †p < 0.05 v placebo group.