Differential actions of vasopeptidase inhibition versus angiotensin-converting enzyme inhibition on diuretic therapy in experimental congestive heart failure

Background-Omapatrilat (OMA), a vasopeptidase inhibitor, simultaneously inhibits angiotensin-converting enzyme (ACE) and neutral endopeptidase, which degrades vasodilatory factors (eg, ADM) and natriuretic peptides. Based on the beneficial cardiorenal and humoral properties of the natriuretic peptides, we hypothesized that an acute vasopeptidase inhibitor with or without diuretic would result in more favorable cardiorenal and hormonal actions than ACE inhibition plus diuretic (ACEI + D) in congestive heart failure. Methods and Results-We compared the actions of OMA alone and with diuretic (OMA + D) to ACEI + D in a model of pacing-induced congestive heart failure. OMA + D decreased pulmonary arterial and pulmonary capillary wedge pressures to a greater level than OMA alone or ACEI + D. Glomerular filtration rate was lower with ACEI + D than with either OMA group. Plasma renin activity and aldosterone immediately increased with ACEI + D, whereas OMA + D resulted in higher plasma renin activity and a delayed increase in aldosterone. OMA alone did not increase plasma renin activity and aldosterone, but resulted in a sustained increase in plasma adrenomedullin, with higher urinary atrial natriuretic, peptide, adrenomedullin, and cGMP excretions than with ACEI + D. Conclusions-Acute administration of OMA with or without diuretic results in more favorable cardiorenal and humoral responses in experimental congestive heart failure than does ACEI + D. There is no acute activation of renin and aldosterone. with OMA alone such as occurs with ACEI + D and OMA + D. Thus, OMA with or without a diuretic possesses beneficial cardiorenal and humoral actions comparable to those observed with ACEI + D that can be explained by potentiation of natriuretic peptides.