尼卡地平和硝普钠在老年人颈动脉内膜剥脱术中控制性降压效果比较

目的观察比较尼卡地平和硝普钠在颈动脉内膜剥脱术时控制性降压的效果。方法择期全身麻醉下行颈动脉内膜剥脱术的患者50例,随机分为两组,每组25人。A组:控制性降压药选用硝普钠;B组:控制性降压药选用尼卡地平。监测并记录入室(T0)、手术开始后10 min(T1)、阻断颈动脉时(T2)、控制性降压后1 min(T3)、控制性降压后5 min(T4)及控制性降压后15 min(T5)各时间点的收缩压(SBP)及心率(HR)并记录术中室性期前收缩、心动过速、术后苏醒延迟、术后躁动以及寒战等不良反应的发生情况。结果与A组比较,B组在T3~T6时间段控制性降压时,达到预期血压的速度更快、更平稳,且心率更稳定。B组术中心律失常的发生率更小,术毕清醒更快,术后几乎不用升压药,预后更好。结论颈动脉内膜剥脱术患者术中应用尼卡地平干预进行控制性降压,可有效预防患者术中出现剧烈的血流动力学波动,避免因心率过快引起心肌氧耗增加导致的心肌缺血及心律失常。     

主动脉夹层瘤覆膜支架介入治疗的麻醉管理及注意事项

目的探讨主动脉夹层瘤覆膜支架介入治疗的麻醉管理及注意事项。方法选择我院自2016年3月至2017年3月收治的40例主动脉夹层瘤患者,对其实施覆膜支架介入治疗,手术前做好患者降压、防感染准备工作,手术过程中行静吸复合麻醉以及采用硝普钠降低血压,在患者体内植入覆膜支架治疗,手术后采取措施预防术后并发症及镇痛。观察比较干预前后患者心率、收缩压、舒张压变化。结果 40例患者覆膜支架植入手术均顺利完成,干预后血流动力学变化明显,差异有统计学意义(P0.05)。结论针对主动脉夹层瘤覆膜支架介入治疗患者,实施静吸复合麻醉以及相应控制血压措施,能够有效提高治疗安全性,实施方便,镇痛效果明显,且易控制,值得临床推广。     

盐酸尼卡地平注射液治疗高血压危象的疗效观察

目的观察评价尼卡地平注射液在高血压危象治疗中的疗效。方法将50例高血压危象患者随机分为盐酸尼卡地平20μg/kg组(Ⅰ组)、盐酸尼卡地平30μg/kg组(Ⅱ组),分别观察给药前(T0)及给药后15 s(T1)、1 min(T2)、15 min(T3)、30 min(T4)的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SPO2)及ECG的变化。结果起效时间两组相似,均为20 s左右;持续时间:Ⅱ组明显长于Ⅰ组(P<0.05),但两组的多数均维持有效降压在10 min以上;用药后两组降压趋势相似,有效率均为100%;出现最低血压时间点两组相似,趋势相同,均在1 min~3 min;最大降压幅度,Ⅱ组SBP明显大于Ⅰ组(P<0.05),DBP两组相似;用药后1 min~10 min两组均有心率增快现象,除增幅变化特点相似外,HR增幅最快,Ⅱ组大于Ⅰ组(P<0.05)。结论盐酸尼卡地平注射液在高血压危象治疗中具有起效快、安全、有效的特点。     

尼卡地平和硝普钠治疗高血压急症的价值比较

目的 :比较静滴尼卡地平和硝普钠治疗急症高血压的疗效和安全性。方法 :急症高血压 （非危急症高血压 ）患者 92例随机分为 2组。尼卡地平组 （4 7例 ）静滴尼卡地平 30 mg,以 0 .6 μg· kg- 1· m in- 1滴速开始 ,每隔 5 m in根据患者血压调节滴速 ,直至达到目标血压后维持该滴速 ,最大剂量不超过 6 μg· kg- 1· m in- 1 ;硝普钠组 4 5例静滴硝普钠 2 5 mg,以 0 .5 μg· kg- 1· m in- 1滴速开始 ,每隔 5 min以 0 .5～ 1.5 μg· kg- 1· min- 1滴速递增 ,直至达到目标血压后维持静滴 ,最大剂量不超过 10 μg· kg- 1· min- 1。结果 :尼卡地平组 SBP从治疗前的 184± 2 2 mm Hg降至用药结束时 12 5± 9mm Hg（P<0 .0 1） ,DBP则从 10 6± 18mm Hg降至 80± 6 mm Hg（P<0 .0 1）。而硝普钠组SBP从 183± 2 1mm Hg降至 12 9± 9m m Hg,DBP从 10 5± 17m m Hg降至 83± 4 mm Hg（P<0 .0 1）。两组的率压积均较治疗前明显降低 （P<0 .0 1）。尼卡地平组不良反应发生 4例 ,硝普钠组不良反应发生 8例 ,两组无显著差异（P>0 .0 5 ）。结论 :静脉应用尼卡地平与硝普钠降压疗效相近 ,不良反应发生率低 ,可用于非危急症的重度高血压患者的治疗。     

乌拉地尔和尼卡地平静脉用药对老年高血压急症患者儿茶酚胺的影响

目的:比较乌拉地尔和尼卡地平治疗老年高血压急症,对患者心率和儿茶酚胺的影响。方法:老年高血压急症患者39例,随机分为A组(乌拉地尔组)22例和B组(尼卡地平组)17例,分别给予乌拉地尔和尼卡地平降压。记录两组患者治疗前﹑治疗60min时﹑离院前的血压、心率水平,并检测患者血中去甲肾上腺素(NE)和肾上腺素(E)的浓度。结果:两组患者降压效果差异无统计学意义(P0.05)。两组治疗后同一时间点HR组间比较差异无统计学意义(P0.05)。A组治疗后与治疗前HR比较差异有统计学意义(P0.05)。B组治疗1h内与治疗前HR比较差异无统计学意义(P0.05),离院前差异有统计学意义(P0.05)。两组在治疗前﹑治疗60min时﹑离院前的血NE和E的组间比较及组内前后比较差异均无统计学意义(P0.05)。结论:以较规范的方法治疗老年高血压急症,乌拉地尔和尼卡地平均可取得满意效果。乌拉地尔在降压全程使心率显著下降,尼卡地平在降压的同时并不显著增加心率,降压一段时间后也可使心率下降。两者均未引起患者血浆儿茶酚胺升高。     

艾司洛尔与尼卡地平治疗急性主动脉夹层的临床效果研究

目的研究分析艾司洛尔与尼卡地平治疗急性主动脉夹层的临床效果。方法将2016年2月-2017年2月期间就诊于本院的急性主动脉夹层患者选为研究对象,共抽取120例。根据患者的入院就诊时间,分为两组,分别使用尼卡地平治疗(单纯组)、艾司洛尔联合尼卡地平治疗(联合组)。将以上两组患者治疗后不同时间段的血压、心率变化情况进行对比,并分析两组患者治疗后血压、心率达标率情况。结果治疗前,两组患者的血压、心率水平对比差异并不显著,P0.05;治疗后6h,两组患者的血压、心率水平均较治疗前改善,P0.05;联合组优于单纯组,P0.05;联合组治疗后6h的血压达标率为85.00%,心率达标率为83.33%,均高于单纯组,P0.05。结论在急性主动脉夹层患者的治疗中,采用艾司洛尔联合尼卡地平治疗的效果显著,在今后临床中具有推荐使用的价值。     

Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层临床诊治分析

目的探讨Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层的机制与诊治。方法回顾性分析自2002年4月至2014年12月沈阳军区总医院心血管内科收治的Stanford B型主动脉夹层中行主动脉腔内修复术患者随访期间发生覆膜支架远端再发夹层的临床特点,同时分析患者发生再次主动脉夹层的影响因素以及诊疗方案。结果 10例主动脉覆膜支架远端再发夹层,7例应用直筒(近端与远端直径无落差)覆膜支架,3例应用近端与远端直径落差均为2 mm的覆膜支架,支架长度均在150 mm以内。9例再次行腔内修复术,1例患者拒绝再次行主动脉腔内修复术,行药物保守治疗。其中1例患者2次出现支架远端再发夹层,2次均行主动脉腔内修复术。所有手术患者均手术成功,无并发症,随访期间2例患者出现脑卒中,分别发生于再次腔内修复术后1个月、6个月,无截瘫和死亡事件。结论注重支架长度及直径落差选择对预防动脉夹层腔内修复术后覆膜支架远端再发夹层有临床意义。再次介入治疗可有效治疗Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层,再次治疗并发症少,安全性高。     

乌拉地尔与硝普钠治疗重度充血性心力衰竭短期临床疗效的对比观察

目的 比较乌拉地尔(利喜定)与硝普钠在治疗重度充血性心力衰竭中的短期临床疗效及安全性.方法 76例纽约心脏协会心功能分级(NYHA)均为Ⅳ级的重度充血性心力衰竭患者随机分为两组:乌拉地尔治疗组38例,硝普钠治疗组38例,在常规治疗的基础上,两组分别持续静脉滴注乌拉地尔100μg/min或硝普钠25μg/min,用药前后观察收缩压(SBP)、舒张压(DBP)、心率(HR)、及心脏做功的变化.结果 两组患者疗效间差异无统计学意义(P>0.05);两组患者用药后SBP、DBP、HR及SBP×HR(心脏做功)较之用药前差异有统计学意义(P<0.05);用药后乌拉地尔组SBP及DBP较硝普钠组差异无统计学意义(P>0.05),但HR及SBP×HR差异有统计学意义(P<0.05).结论 乌拉地尔治疗重度充血性心力衰竭时降压平稳而安全,无血管扩张所致的反射性心率加快,明显减少心脏做功,可作为重度充血性心力衰竭的常规治疗药物.     

尼卡地平对妊娠期高血压的降压疗效及安全性研究

目的探讨尼卡地平治疗妊娠期高血压的临床疗效和安全性。方法选择2009年3月至2010年3月上海交通大学医学院附属仁济医院、首都医科大学附属北京妇产医院和浙江大学医学院附属妇产科医院收治的的妊娠期高血压患者62例,随机分为尼卡地平组32例和拉贝洛尔组30例。观察各组治疗前后的血压变化情况、围产儿结局和药物不良反应。结果尼卡地平组患者在用药1 h后达到目标血压,13例患者24 h后改为口服用药,7例患者需要联合降压治疗。拉贝洛尔组患者用药4 h达到目标血压,9例患者改为口服,11例患者联合降压治疗。两组降压疗效差异具有统计学意义(P<0.05)。尼卡地平组新生儿体重和胎盘重量明显高于拉贝洛尔组(P<0.05)。两组患者用药前后心率变化差异无统计学意义(P>0.05)。结论尼卡地平可有效控制血压,可改善围产儿结局。     

乌拉地尔治疗颈椎前路手术中交感性心血管反应的临床观察

目的以血压(SBP)和心率(HR)为指标,观察乌拉地尔(国产利喜定)和尼卡地平(国产佩尔地平)治疗颈椎前路手术中交感性心血管反应的效果.方法选择择期行颈椎前路手术、ASAⅠ～Ⅱ级患者120例,随机平均分为3组乌拉地尔组(URA组)和尼卡地平组(NIC组)分别于手术牵拉交感神经血压升高、心率增快时给予乌拉地尔0.5mg/kg和尼卡地平5μg/kg;对照组(COM组)于手术同一时间则仅用异氟醚适当加深麻醉.分别记录和比较手术牵拉交感神经前、用药后5min、10min时的心率和心血压.结果在手术中牵拉感神经时乌拉地尔组给药后血压和心率均没有明显的变化,尼卡地平组给药后血压虽无明显的变化,但心率却显著升高,而对照组在牵拉交感神经时虽经加深麻醉,但血压和心率都有明显的升高.结论乌拉地尔与尼卡地平比较,能够有效治疗颈椎前路手术中患者交感性心血管反应.     

右旋美托咪啶用于覆膜支架腔内隔绝术中镇静的随机双盲对照研究

目的:探讨观察右美旋托咪啶用于B型主动脉夹层覆膜支架腔内隔绝术中的镇静效果及安全性。方法:局麻复合强化麻醉下行覆膜支架腔内隔绝手术的患者60例,随机分为右旋美托咪啶组(D组)和芬太尼+咪达唑仑组(C组),每组30例,采用静脉注射,给药时间持续10 min,观察给药后即刻(基础值),5 min(T1)、8 min(T2)、10 min(T3)、12 min(T4)、15 min(T5)、20 min(T6)、25 min(T7)及30min(T8)的血压、心率(HR)、呼吸频率、经皮血氧饱和度(SpO2)、脑电双频谱(BIS)值及改良警觉、镇静观察评分变化并记录有无术中不良反应。结果:与基础值比较,D组T3～T8时收缩压(SBP)降低和舒张压(DBP)降低,T3～T8时HR降低,T4～T7时镇静评分降低,T5、T6时BIS值降低;C组T3时SBP降低,T4时镇静评分降低(P<0.05或P<0.01)。与C组比较,D组在T5～T7时SBP降低,在T6、T7时DBP降低,T3～T6时HR降低,T5、T6时镇静评分降低,T5、T6时BIS值降低,发生呼吸抑制及恶心呕吐的发生率降低(P<0.05或P<0.01)。2组各时点呼吸频率(RR)和血氧饱和度(SpO2)比较,差异无统计学意义(P>0.05)。结论:右旋美托咪啶具有良好的镇静效果,对呼吸影响小,不良反应轻微,可安全用于覆膜支架腔内隔绝术中镇静。     

Antihypertensive and anti-ischemic effects of nicardipine and nitroprusside in patients undergoing coronary artery bypass grafting

The efficacy of nicardipine vs nitroprusside in controlling hypertension after sternotomy was compared in 120 patients undergoing coronary artery bypass grafting and anesthetized with fentanyl (100 micrograms/kg). All had good left ventricular function and had been receiving long term oral beta-blocking therapy. Patients were randomly allocated to 1 of 3 groups: group C, the control (n = 40), received no vasodilator; group N (n = 40) received intravenous nicardipine at an initial rate of 3 micrograms/kg/min; and group S (n = 40) received intravenous nitroprusside at an initial rate of 1 microgram/kg/min. Vasodilator infusion was begun before surgery and infusion rates were adjusted to maintain systolic blood pressure between 80 and 120% of postintubation (baseline) values. Additional measurements were obtained before incision and after sternotomy. In groups N and S, arterial blood pressure was effectively controlled in all patients. Before the incision, pulmonary artery pressure decreased in group S and systemic vascular resistance decreased in groups N and S. After sternotomy, mean arterial pressure, heart rate, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index and rate-pressure product increased in group C. At this time, pulmonary artery pressure returned to baseline values in group S. In groups N and S, heart rate, cardiac index and rate-pressure product increased, but, compared with baseline values, systemic vascular resistance remained low after sternotomy. Ischemic changes were seen in the electrocardiogram in 11 patients (28%) in group C, 10 patients (25%) in group S and 4 patients (10%) in group N. The concentration of creatine phosphokinase MB was not significantly different in the first 24 postoperative hours in any group.     

Rapid pacing for better placing: comparison of techniques for precise deployment of endografts in the thoracic aorta.

PURPOSE: To investigate the safety, efficacy, impact on positioning, and neurocognitive outcomes of 3 conceptually different methods of avoiding the "windsock" effect during thoracic stent-graft placement. METHODS: A retrospective review was conducted of 70 patients (48 men; mean age 63 years) who underwent elective or emergency stent-graft placement in the thoracic aorta for various pathologies. Twenty-seven patients (18 men; mean age 64+/-12 years) had stent-graft positioning during rapid right ventricular (RV) pacing at 180 to 200 beats per minute. Another 27 patients (18 men; mean age 62+/-12 years) had stent-graft placement under controlled hypotension (相似文献   

Benzodiazepine and opioid sedation attenuate the sympathetic response to fiberoptic bronchoscopy. Prophylactic labetalol gave no additional benefit. Results of a randomized double-blind placebo-controlled study

BACKGROUND: Hypertension and tachycardia are common during fiber-optic bronchoscopy (FOB), and this may lead to cardiac ischemia. The prophylactic addition of a beta-adrenergic anatagonist might mask this response and prevent the deleterious cardiovascular effects of FOB. METHODS: We performed a randomized double-blind placebo-controlled trial of labetalol 10mg iv given with midazolam-alfentanil sedation. We monitored heart rate (HR) and systolic/diastolic blood pressure (SBP/DBP) throughout the bronchoscopy and calculated the rate-pressure product (RPP=(HRxSBP)/100). One-hundred twenty patients were enrolled. RESULTS: In the placebo group, there was no rise in HR, SBP, DBP or RPP, and there was no difference between the placebo and labetalol groups. Adverse events during bronchoscopy were similar in both groups. In a subgroup of patients undergoing interventional bronchoscopy, there was a trend towards lower SBP (p=0.06). CONCLUSIONS: Patients undergoing FOB under adequate midazolam-alfentanil sedation do not develop excessive sympathetic drive that may lead to cardiac stress. The addition of labetalol did not confer additional benefit or risk to the patients. (ClinicalTrials.gov number, NCT00394537).     

乌拉地尔和尼卡地平对老年高血压急症的疗效及安全性比较

目的探讨乌拉地尔和尼卡地平治疗老年高血压急症的疗效和不良反应。方法老年高血压急症患者39例,随机分为乌拉地尔组22例和尼卡地平组17例,分别给予乌拉地尔和尼卡地平降压,记录2组治疗前及治疗后5、10、15、20、25、30、60min、2h及离院时收缩压、舒张压、平均动脉压(MAP)和心率及不良反应。结果 2组治疗前后收缩压、舒张压、MAP和心率比较,差异无统计学意义(P>0.05);2组治疗前后不同时间点收缩压与治疗前收缩压差值比较,差异无统计学意义(P>0.05);2组治疗后2h舒张压和MAP与治疗前差值比较,差异有统计学意义(P<0.05,P<0.01),乌拉地尔组下降更加明显(P<0.01)。结论乌拉地尔和尼卡地平对老年高血压急症症状的缓解及对收缩压降压效果相当;乌拉地尔起效更快且有进一步使舒张压和MAP降低的趋势;2组均可使心率下降,尼卡地平治疗早期患者心率可一过性上升,但并不显著增加心率;2种药物安全性均较好。     

尼卡地平注射液对手术后高血压的疗效

目的　研究国产尼卡地平注射液在术后高血压中的应用。方法　采用随机、双盲和安慰剂对照的方法 ,将 40例各种普通外科手术后 2 4h内发生高血压患者随机分为治疗组 (2 0例 ,使用泰尼注射液 )和对照组 (2 0例 ,使用安慰剂 )。结果　治疗组的有效率为 95 % (19/2 0 ) ,对照组为 10 % (2 /2 0 ) (P <0 .0 0 1)。治疗组在剂量调整期的平均起效时间为 (11.9± 0 .4)min ,起效时的平均滴注速率为 (12 .8± 0 .4)mg/h。在维持期 ,平均维持滴注时间为 (6 .8±0 .6 )h ,平均维持速率为 (3.1± 0 .3)mg/h[(0 .34～ 11.88)mg/h]。不良反应较少。结论　尼卡地平注射液可安全有效地用于术后高血压患者     

预扩容对老年人腰硬联合麻醉下行TVP术血流动力学的影响

目的观察琥珀酰明胶注射液（商品名：佳乐施）预扩容对老年人腰硬联合麻醉（CSEA）下行经尿道前列腺汽化电切术（TVP）血流动力学的影响。方法择期行TVP术的老年病人60例，按美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，随机分为预输注佳乐施组（G组），乳酸钠林格液组（R组），每组各30例。麻醉前分剐以15ml／（kg·h）的速度输入佳乐施或乳酸钠林格氏液500ml，麻醉后2组病人输液管理相似。观察麻醉后5、15、30、45min各时点病人的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、中心静脉压（CVP）的变化，记录发生低血压、恶心呕吐及应用麻黄碱的例数。结果 2组扩容后MAP、CVP有所升高，但均在正常范围内。麻醉后15、30、45min各时点R组的MAP、CVP与G组比较明显降低（P〈0．05），G组的血流动力学稳定，R组发生低血压、恶心呕吐及应用麻黄碱的例数多于G组（P〈0．05）。结论老年人在腰硬联合麻醉下行TVP术，预输注佳乐施能保持病人术中血流动力学稳定，减少低血压、恶心呕吐等不良反应的发生率。     

Ketanserin in the treatment of systemic hypertension during and following coronary artery bypass surgery

One of the most important problems during cardiac surgery is the prevention and treatment of hypertension, occurring in 40-60% of the patients following coronary artery bypass surgery (CABS). Hypertension should be avoided to prevent myocardial damage, neurologic complications, increased blood loss, and premature graft closure due to intimal damage. During and following cardiac surgery hypertension is routinely treated with vasodilating agents, which generally induce reflex tachycardia and increased intrapulmonary shunting. The results obtained with ketanserin, a specific S2-serotonergic receptor blocker with alpha 1-adrenergic receptor blocking properties, in the prevention and treatment of hypertension in patients undergoing cardiac surgery, are presented. Ketanserin effectively lowers blood pressure by decreasing systemic vascular resistance but does not completely prevent perioperative and postoperative hypertension when administered as a continuous infusion from the start of anesthesia. In contrast to sodium nitroprusside, ketanserin does not induce reflex tachycardia in the treatment of postoperative systemic hypertension following CABS. The compound improves diuresis and perfusion of the skin perioperatively. Ketanserin is devoid of rebound phenomena after its administration is stopped. It is postulated that the antihypertensive effect of ketanserin can be explained by its property of simultaneously blocking alpha 1-adrenergic and S2-serotonergic receptors.     

Effects of experimental hypotension on hemodynamics and renin secretion rate

The effects of hypotension on systemic and renal hemodynamics, plasma renin activity (PRA), and renin secretion rate (RSR) were determined in dogs anesthetized with sodium pentobarbital plus chloralose. Renal blood flow (RBF) was determined with microspheres (15 micron) and with an electromagnetic flowmeter connected to an extra-corporeal circuit from the femoral artery to the renal artery. Hypotension was induced by nitroprusside infusion, which decreased peripheral resistance, and by hemorrhage, which reduced cardiac output. RSR increased in both forms of hypotension, but the increase following hemorrhage was greater than that after nitroprusside. Thus, when the mean arterial pressure (MAP) was reduced to 75 mmHg, RSR increased from 470 +/- 26 units/min to 990 +/- 12 units/min with nitroprusside and from 415 +/- 13 units/min to 1,509 +/- 21 units/min following hemorrhage. At MAP of 50 mmHg, RSR increased to 1,541 +/- 64 units/min with nitroprusside and to 2,254 +/- 98 units/min following hemorrhage. Nitroprusside increased renin secretion not only by an increase in sympathetic beta adrenergic activity through the baroreceptor reflex, but also by its direct vasolidatory effect in the renal circulation. In hemorrhagic hypotension, the increase in renin secretion was accompanied by renal vasoconstriction. The greater increase in RSR following hemorrhage than after nitroprusside at given levels of hypotension may be explained by a stronger beta adrenergic activation, the activation of prostaglandin and kallikrein systems, a lower microvascular pressure level, and/or smaller pulse pressure and lower sodium load in the macula densa. The comparison of renin secretion at the same degree of hypotension induced by different hemodynamic alterations serves to elucidate the mechanisms of renin secretion.     

Low Dose of ACE-Inhibitor Enhances Sodium Excretion in Volume Expanded Patients with Borderline Hypertension

Borghi C, Boschi S, Costa FV, Bacchelli S, Degli Esposti D, Immordino V, Piccoli M, Ambrosioni E.: Low dose of ACE-inhibitor enhances sodium excretion in volume expanded patients with borderline hypertension.

The purpose of the present study was to separately investigate the effects of two different dosages of captopril on pressor, vascular and humoral response to acute extracellular volume expansion in patients with borderline hypertension (BHT). Thirty-five patients were randomly allocated in two groups undergoing acute saline infusion (0.40 ml/min/kg for 45min and 0.15 ml/min/kg for 75 min) before and after a 7-day period of treatment with either placebo or captopril at the dose of 12.5 (LD-CAP) or 50 mg (HD-CAP) twice a day. At baseline the effects of LD-CAP were limited to an increase in PRA and to a decrease in plasma aldosterone whereas HD-CAP decreased systolic and diastolic blood pressure (SBP, DBP), forearm vascular resistance (FVR) and increased venous distensibility (VV₃₀) as well. After saline loading patients treated with HD-CAP showed an increase in SBP, DBP not observed in patients allocated to LD-CAP. Urinary sodium excretion in response to NaCl loading was selectively enhanced by LD-CAP (+25%) whereas HD-CAP did not (+6.3%). The present data suggest that low-doses of ACE-inhibitors acting through a selective blockade of RAA not associated with hemodynamic changes can enhance the natriuretic response to acute volume expansion in borderline hypertensives.