ENALAPRIL PREVENTS IMMINENT AND REDUCES MANIFEST CEREBRAL EDEMA IN STROKE-PRONE HYPERTENSIVE RATS

Citation
Ela. Blezer et al., ENALAPRIL PREVENTS IMMINENT AND REDUCES MANIFEST CEREBRAL EDEMA IN STROKE-PRONE HYPERTENSIVE RATS, Stroke, 29(8), 1998, pp. 1671-1677
Citations number
28
Categorie Soggetti
Peripheal Vascular Diseas","Clinical Neurology
Journal title
StrokeACNP
ISSN journal
00392499
Volume
29
Issue
8
Year of publication
1998
Pages
1671 - 1677
Database
ISI
SICI code
0039-2499(1998)29:8<1671:EPIARM>2.0.ZU;2-4
Abstract
Background and Purpose-Stroke-prone spontaneously hypertensive rats (S HRSP), subjected to high NaCl intake, show severe hypertension, organ damage, and early death. Preventive treatment with an angiotensin-conv erting enzyme (ACE) inhibitor is known to reduce mortality. Previously we found that proteinuria always precedes cerebral edema in SHRSP. He nce, in this study ACE inhibition was started later, ie, directly afte r manifestation of either proteinuria or cerebral edema. Methods-SHRSP were subjected to 1% NaCl intake. Group 1 served as a control. In gro up 2 early-onset treatment with the ACE inhibitor enalapril was initia ted after proteinuria was >40 mg/d. In group 3 late-onset ACE inhibiti on was started after the first observation of cerebral edema with T2-w eighted MRT. Cerebral edema was expressed as the percentage of pixels with an intensity above a defined threshold. Results-In controls media n survival was 54 days (range, 32 to 80 days) after start of salt load ing. The terminal level of cerebral edema was 19.0+/-3.0%. Under early -onset enalapril, median survival increased to 320 days (range, 134 to 368 days; P<0.01 versus group 1), Cerebral edema was prevented in all but 1 rat. Systolic blood pressure was slightly and transiently reduc ed at day 14. Proteinuria was markedly reduced (52+/-7 versus 190+/-46 mg/d in group 1 at day 7; P<0.05), Under late-onset enalapril, median survival was 264 days (range, 154 to 319 days; P<0.01 versus group 1) . Cerebral edema decreased to baseline levels (9.6+/-2.9 at day 0 to 3 .4+/-0.5% at day 3; (P<0.05). Ultimately cerebral edema reoccurred in 6 of the 8 rats. SEP decreased slightly at day 7 only. Proteinuria dec reased from 283+/-27 at day 0 to 116+/-22 mg/d at day 7 (P<0.05). Comp lete remission of the original locus of cerebral edema was confirmed h istologically. Conclusions-In SHRSP with proteinuria, treatment with a n ACE inhibitor both prevented the development of cerebral edema and r educed manifest cerebral edema and proteinuria. Survival was markedly prolonged. These findings support the use of ACE inhibition for treatm ent in hypertensive encephalopathy.