Angiotensin-converting enzyme inhibition and endothelin antagonism for endothelial dysfunction in heart failure:: mono- or combination therapy

The effect of angiotensin-converting enzyme (ACE) inhibition and endothelin A (ETA) receptor antagonism alone and in combination on endothelial vasomotor dysfunction in chronic heart failure (CHF) was compared. Vasoreactivity and superoxide anion formation were determined in aortic rings from Wistar rats with experimental CHF 12 weeks after extensive myocardial infarction compared with sham-operated animals. Rats were treated with placebo, with the ETA receptor antagonist LU 135252 (30 mg/kg/d), with the ACE inhibitor trandolapril (0.3 mg/kg/d), or with a combination of LU 135252 and trandolapril. Infarct size was similar among the groups. In the placebo group, the concentration-response curve of the endothelium-dependent, acetylcholine-induced relaxation was significantly shifted to the right and the maximum relaxation was attenuated (R-max 53 +/- 3%) compared with the sham placebo group (R-max 72 +/- 3%). Treatment with LU 135252 as well as trandolapril significantly improved acetylcholine-induced maximum relaxation (LU 135252 66 +/- 4%, trandolapril 67 +/- 4%, p < 0.05 versus CHF placebo). In addition to R-max (LU 135252/trandolapril 70 +/- 4%), combination therapy also improved the pathologic rightward shift (p < 0.05). Increased O-2(-) production in CHF was significantly reduced in all treatment groups. The increased relaxation elicited by exogenous superoxide dismutase in CHF was reduced to normal values by monotherapy and further attenuated by combination treatment. Although monotherapy with the ACE inhibitor trandolapril and the ETA receptor antagonist LU 135252 improved endothelial dysfunction in experimental CHF, combination therapy was more effective.