Effect of Activation and Inhibition of the Renin-Angiotensin System on Plasma PAI-1

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 32; no. 6; pp. 965 - 971
• Main Authors: Brown, Nancy J, Agirbasli, Mehmet A, Williams, Gordon H, Litchfield, W. Reid, Vaughan, Douglas E
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.12.1998; Hagerstown, MD Lippincott
• Subjects: Adult; Aldosterone - blood; Angiotensin-Converting Enzyme Inhibitors - pharmacology; Biological and medical sciences; Cardiology. Vascular system; Catecholamines - blood; Circadian Rhythm; Coronary heart disease; Creatinine - urine; Diet, Sodium-Restricted; Fibrinolysis; Heart; Hemodynamics; Humans; Hydrocortisone - blood; Isoquinolines - pharmacology; Male; Medical sciences; Plasminogen Activator Inhibitor 1 - blood; Quinapril; Renin - blood; Renin-Angiotensin System - physiology; Sodium - urine; Space life sciences; Supine Position; Tetrahydroisoquinolines; Tissue Plasminogen Activator - blood; Human; Quinapril; Enzyme; Interaction; Enzyme inhibitor; Cardiovascular disease; Activation; Fibrinolysis; Biological activity; Prevention; Peptidases; Chemotherapy; Renin angiotensin system; Alteplase; Treatment; Peptidyl-dipeptidase A; Hydrolases; Peptidyl-dipeptidases; Inhibition
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/01.HYP.32.6.965

Increased plasma renin activity (PRA) has been associated with an increased risk of myocardial infarction (MI), whereas angiotensin-converting enzyme (ACE) inhibition appears to reduce the risk of recurrent MI in patients with left ventricular dysfunction. These observations may be partially explained by an interaction between the renin-angiotensin system (RAS) and fibrinolytic system. To test this hypothesis, we examined the effect of salt depletion on tissue-type plasminogen activator (tPA) antigen and plasminogen activator inhibitor-1 (PAI-1) activity and antigen in normotensive subjects in the presence and absence of quinapril (40 mg BID). Under low (10 mmol/d) and high (200 mmol/d) salt conditions there was significant diurnal variation in PAI-1 antigen and activity and tPA antigen. Morning (8 AM through 2 PM) PAI-1 antigen levels were significantly higher during low salt intake compared with high salt intake conditions (ANOVA, F=5.8, P=0.048). PAI-1 antigen correlated with aldosterone (r=0.56, P<10) during low salt intake. ACE inhibition significantly decreased 24-hour (ANOVA for 24 hours, F=6.7, P=0.04) and morning (F=24, P=0.002) PAI-1 antigen and PAI-1 activity (F=6.48, P=0.038) but did not alter tPA antigen. Thus, the mean morning PAI-1 antigen concentration was significantly higher during low salt intake than during either high salt intake or low salt intake and concomitant ACE inhibition (22.7 +/- 4.6 versus 16.1 +/- 3.3 and 16.3 +/- 3.7 ng/mL, respectively; P<0.05). This study provides evidence of a direct functional link between the RAS and fibrinolytic system in humans. The data suggest that ACE inhibition has the potential to reduce the incidence of thrombotic cardiovascular events by blunting the morning peak in PAI-1. (Hypertension. 1998;32:965-971.)