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Effect of Combined AT₁ Receptor and Aldosterone Receptor Antagonism on Plasminogen Activator Inhibitor-1

Divisions of Clinical Pharmacology (P.S., L.J.M., S.K., N.J.B.), Pediatric Endocrinology (P.S.), and Cardiovascular Medicine (D.E.V.), Vanderbilt University Medical Center, Nashville, Tennessee 37232-6602

Address all correspondence and requests for reprints to: Nancy J. Brown, M.D., 560 Robinson Research Building, Vanderbilt University Medical Center, Nashville, Tennessee 37232-6602. E-mail: nancy.j.brown{at}vanderbilt.edu.

Aldosterone enhances angiotensin II (Ang II)-induced plasminogen activator inhibitor (PAI)-1 expression in vitro. This study tested the hypothesis that angiotensin II type 1 (AT₁) and aldosterone receptor antagonism interact to decrease PAI-1 in humans. Effects of candesartan (16 mg/d), spironolactone (25 mg/d), or combined candesartan/spironolactone on mean arterial pressure (MAP), endocrine, and fibrinolytic variables were measured in 18 normotensive subjects [age 33.7 yr (95% confidence interval 29.3, 38.0), body mass index 26.6 (24.7, 28.4) kg/m²] in whom the renin-angiotensin-aldosterone system was activated by furosemide (20 mg/d). Candesartan [83.3 mm Hg (78.9, 87.7)], but not spironolactone [89.4 mm Hg (85.4, 93.5)], decreased MAP, compared with baseline [92.2 mm Hg (88.9, 95.5), P < 0.001] and furosemide alone [89.1 mm Hg (85.7, 92.4), P = 0.002]. Coadministration of spironolactone with candesartan did not further decrease MAP. Candesartan dramatically increased Ang II [177.9 pg/ml (113.3, 242.6)], compared with baseline [34.8 pg/ml (29.3, 40.4), P = 0.002] and furosemide alone [40.6 pg/ml (29.7, 51.5), P = 0.003]. Spironolactone increased Ang II [51.5 pg/ml (41.3, 61.7), P = 0.014 vs. baseline, P = 0.004 vs. candesartan]. There was no additive effect of candesartan and spironolactone on Ang II [197.6 pg/ml (134.2, 261.0)]. Aldosterone was lower during candesartan [8.9 ng/dl (7.3, 10.6), P = 0.007] than during furosemide alone [14.1 ng/dl (10.9, 17.3), P = 0.007], spironolactone [18.7 ng/dl (14.5, 22.9), P = 0.002], or combined candesartan/spironolactone [13.9 ng/dl (11.8, 15.9), P = 0.006]. Furosemide increased PAI-1 antigen [27.8 ng/ml (20.6, 35.0), P = 0.002 vs. 19.3 ng/ml (13.4, 25.2) baseline], even in the presence of candesartan [27.2 ng/ml (16.5, 37.8), P = 0.042 vs. baseline] or spironolactone [27.3 ng/ml (17.9, 36.8), P = 0.015 vs. baseline]. However, coadministration of AT₁ and aldosterone receptor antagonists prevented the furosemide-induced increase in PAI-1 [19.2 ng/ml (9.8, 28.6), P = 0.974 vs. baseline, P < 0.05 vs. candesartan, spironolactone or furosemide alone]. This study evidences an interactive effect of endogenous Ang II and aldosterone on PAI-1 production in humans.

This work was supported by an unrestricted grant from AstraZenica and NIH Grants RO1HL67308, RO1HL60906, RO1HL65193, K23HL04445, MO1RR00095, and GM07569.

Abbreviations: ACE, Angiotensin-converting enzyme; Ang II, angiotensin II; AT₁, angiotensin II type 1; BP, blood pressure; MAP, mean arterial pressure; MR, mineralocorticoid receptor; PAI-1, plasminogen activator inhibitor-1; PRA, plasma renin activity; RAAS, renin-angiotensin-aldosterone system; t-PA, tissue-type plasminogen activator.

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