Photo Credit: ALIOUI Mohammed Elamine
The following is a summary of the “ACE inhibitors and angiotensin receptor blockers differentially alter the response to angiotensin II treatment in vasodilatory shock,” published in the April 2024 issue of Critical Care by Leisman et al.
Researchers conducted a retrospective study investigating how prior use of Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) affects the response to angiotensin-II treatment in vasodilatory shock.
They conducted a post-hoc subgroup analysis in the randomized, placebo-controlled ATHOS-3 trial. They compared patients using chronic ACEi or ARB to those without. The main focus was on mean arterial pressure after 1 hour of treatment. Additional outcomes featured mean arterial pressure, norepinephrine equivalent dose, and study-drug dose over time. Biological outcomes covered baseline RAS biomarkers (renin, angiotensin-I, angiotensin-II, and angiotensin-I/angiotensin-II ratio) and the change in renin from 0 to 3 hours.
The results showed that in patients with vasodilatory shock who were not previously exposed to ACEi or ARBs, angiotensin-II treatment increased blood pressure and reduced the need for vasopressor medications compared to placebo. For patients who had previously taken ACEi, angiotensin-II treatment increased blood pressure to a similar extent as in those not previously exposed. Still, it led to a greater reduction in vasopressor requirements. Patients who had previously taken ARBs showed a blunted response to angiotensin-II treatment, with smaller increases in blood pressure and less reduction in vasopressor needs. Patient’s prior medication use can influence how they respond to angiotensin-II therapy for vasodilatory shock.
Investigators concluded that prior use of ACE inhibitors heightened responsiveness to angiotensin-II treatment in vasodilatory shock, while prior ARBs blunted it.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04910-6