Marked bradykinin-induced tissue plasminogen activator release in patients with heart failure maintained on long-term angiotensin-converting enzyme inhibitor therapy

J Am Coll Cardiol. 2002 Sep 4;40(5):961-6. doi: 10.1016/s0735-1097(02)02061-2.


Objectives: The aim of the present study was to assess the contribution of angiotensin-converting enzyme (ACE) inhibitor therapy to bradykinin-induced tissue-type plasminogen activator (t-PA) release in patients with heart failure (HF) secondary to ischemic heart disease.

Background: Bradykinin is a potent endothelial cell stimulant that causes vasodilatation and t-PA release. In large-scale clinical trials, ACE inhibitor therapy prevents ischemic events.

Methods: Nine patients with symptomatic HF were evaluated on two occasions: during and following seven-day withdrawal of long-term ACE inhibitor therapy. Forearm blood flow was measured using bilateral venous occlusion plethysmography. Intrabrachial bradykinin (30 to 300 pmol/min), substance P (2 to 8 pmol/min), and sodium nitroprusside (1 to 4 pmol/min) were infused, and venous blood samples were withdrawn from both forearms for estimation of fibrinolytic variables.

Results: On both study days, bradykinin and substance P caused dose-dependent vasodilatation and release of t-PA from the infused forearm (p < 0.05 by analysis of variance [ANOVA]). Long-term ACE inhibitor therapy caused an increase in forearm vasodilatation (p < 0.05 by ANOVA) and t-PA release (p < 0.001 by ANOVA) during bradykinin, but not substance P, infusion. Maximal local plasma t-PA activity concentrations approached 100 IU/ml, and maximal forearm protein release was approximately 4.5 microg/min.

Conclusions: Long-term ACE inhibitor therapy augments bradykinin-induced peripheral vasodilatation and local t-PA release in patients with HF due to ischemic heart disease. Local plasma t-PA activity concentrations approached those seen during systemic thrombolytic therapy for acute myocardial infarction. This may contribute to the primary mechanism of the anti-ischemic effects associated with long-term ACE inhibitor therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bradykinin / pharmacology*
  • Female
  • Glyceraldehyde-3-Phosphate Dehydrogenases / therapeutic use*
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology*
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Peptide Fragments / therapeutic use*
  • Plethysmography
  • Substance P
  • Tissue Plasminogen Activator / metabolism*
  • Vasomotor System / drug effects


  • Peptide Fragments
  • glyceraldehyde 3-phosphate dehydrogenase (304-313)
  • Substance P
  • Glyceraldehyde-3-Phosphate Dehydrogenases
  • Tissue Plasminogen Activator
  • Bradykinin