Hemodynamics and renal local natriuretic systems in early stages of heart failure. Effect of long-term therapy with perindopril

Aim. To study mechanisms of regulation of renal hemodynamics and natriuresi s in patients with incipient heart failure. Material and methods. Sixty one patients with ischemic heart disease with functional class 0-II heart fail ure were studied before and after 6 months of therapy with perindopril. Res ults and conclusions. Participation of renal kinin system in regulation of diuresis and natriuresis in patients with ischemic heart disease without si gns of heart failure was revealed. In patients with class I heart failure u rinary kallikrein excretion was elevated and correlations with parameters o f renal hemodynamics were present. In class II heart failure activity of re nal kinin system was decreased what was associated with impairment of renal blood flow and increase of proximal sodium reabsorption. Effect of renal d opaminergic system on local hemodynamics and natriuresis was most pronounce d in the absence of heart failure. In patients with class III heart failure urinary excretion of dopamine was lowered. No relationships were found bet ween renal kinin and dopaminergic systems. Therapy with perindopril for 6 m onths was associated with improvement of parameters of renal hemodynamics, augmentation of natriuresis and normalization of urinary excretion of kalli krein while dopamine excretion was not affected.