Ts. Rector et al., RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY OF SUPPLEMENTAL ORAL L-ARGININE IN PATIENTS WITH HEART-FAILURE, Circulation, 93(12), 1996, pp. 2135-2141
Background Patients with heart failure have reduced peripheral blood f
low at rest, during exercise, and in response to endothelium-dependent
vasodilators. Nitric oxide formed from L-arginine metabolism in endot
helial cells contributes to regu lation of blood flow under these cond
itions. A randomized, double-blind crossover study design was used to
determine whether supplemental oral L-arginine can augment peripheral
blood flow and improve functional status in patients with moderate to
severe heart failure. Methods and Results Fifteen subjects were given
6 weeks of oral L-arginine hydrochloride (5.6 to 12.6 g/d) and 6 weeks
of matched placebo capsules in random sequence. Compared with placebo
, supplemental oral L-arginine significantly increased forearm blood f
low during forearm exercise, on average from 5.1 +/- 2.8 to 6.6 +/- 3.
4 mL . min(-1). dL(-1) (P<.05). Furthermore, functional status was sig
nificantly better on L-arginine compared with placebo, as indicated by
increased distances during a 6-minute walk test (390 +/- 91 versus 42
2 +/- 86 m, P<.05) and lower scores on the Living With Heart Failure q
uestionnaire (55 +/- 28 versus 42 +/- 26, P<.05). Oral L-arginine also
improved arterial compliance from 1.99 +/- 0.38 to 2.36 +/- 0.30 mL/m
m Hg (P<.001) and reduced circulating levels of endothelin from 1.9 +/
- 1.1 to 1.5 +/- 1.1 pmol/L (P<.05). Conclusions Supplemental oral L-a
rginine had beneficial effects in patients with heart failure. Further
studies are needed to confirm the therapeutic potential of supplement
al oral L-arginine and to identify mechanisms of action in patients wi
th heart failure.