REGIONAL HEMODYNAMIC-EFFECTS OF PERINDOPRIL IN CONGESTIVE-HEART-FAILURE

The onset of heart failure is associated with complex neurohumoral, ca rdiac, and vascular changes. These disorders partly explain that, in t his situation, regional distribution of blood flows is hardly modified with stability or increase in heart and brain flows and impairment of limb, renal, and splanchnic blood flows. Using the bidimensional Dopp ler technique to measure brachial blood flow and diameter and standard clearance techniques to determine renal and hepatic blood flows, we s tudied the effects of perindopril, a long-lasting angiotensin-converti ng enzyme inhibitor, on regional hemodynamics. We demonstrated that pe rindopril produces a very marked increase in forearm and kidney flows but a very minor increase in the hepatosplanchnic territory, resulting in a regional distribution of cardiac output that favors the renal an d musculocutaneous territories. This mechanism of action might be an i mportant contribution to clinical improvement observed with perindopri l.