Cardiothoracic & vascular anesthesia
Renin-angiotensin-aldosterone system dynamics after targeted blood pressure control using angiotensin II or norepinephrine in cardiac surgery: mechanistic randomised controlled trial
Authors' conclusion
Angiotensin II suppressed renin release while maintaining aldosterone levels compared with norepinephrine. Higher plasma renin concentration before surgery was associated with greater vasopressor requirement for norepinephrine, but not angiotensin II.
Study context
- Population
- Cardiac surgery patients11.7% female
- Participants
- 60 patients
- Comparison
- Angiotensin II vs Norepinephrine
- Primary endpoint
- Plasma renin concentration (PRC)
- Follow-up
- ICU admission
Methodological detailsdouble-blind, mechanistic
- Double-blind
- Mechanistic
Primary result
As reported in the abstract
Median difference
46 μU ml-1
P < 0.001
Norepinephrine · IQR 3-88; within-group change
Median difference
−3 μU ml-1
P = 0.36
Angiotensin II vs Norepinephrine · IQR −62 to 35; within-group change
Further findings
Aldosterone:Plasma renin concentration (PRC) ratio
| Median difference (μU ml-1 per ng dl-1) | P value | |
|---|---|---|
| NorepinephrineIQR −0.14 to 0.03; within-group change | −0.01 | P = 0.76 |
| Angiotensin IIIQR 0.004-0.26; within-group change | 0.05 | P < 0.001 |
Aldosterone
- Aldosterone levels increased with both
Preoperative PRC upper quartile and vasopressor requirement
- Upper quartile of preoperative PRC associated with higher vasopressor requirements with norepinephrine, but not angiotensin II
Dipeptidyl peptidase-3 and angiotensin-converting enzyme 2 activity
- Similar at all time points
Original publication
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