Partial angiotension-converting enzyme inhibition during acute orthostatic stress in persons with tetraplegia

Jill M. Wecht, Miroslav Radulovic, Joseph P. Weir, Joanah Lessey, Ann M. Spungen, William A. Bauman

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23 Scopus citations


Introduction: Individuals with tetraplegia rely on the renin-angiotensin system for orthostatic blood pressure control. Objectives: To determine the effect of partial angiotensin-converting enzyme (ACE) inhibition on heart rate (HR), active plasma renin (PR), and mean arterial blood pressure (MAP) during acute orthostasis in subjects with tetraplegia (n = 7) and nondisabled persons (n = 8). Methods: Subjects were instructed to avoid caffeine and alcohol for 24 hours before testing and to report to the laboratory between 10 AM and 1 PM. Progressive head-up tilt (15°, 25°, 35°, and 45°) was performed on 2 separate days; Day 1: without ACE inhibition; Day 2: after intravenous (IV) infusion of enalaprilat (0.625 mg). Results: HR was reduced during orthostasis in the tetraplegia compared with the nondisabled group (P < 0.0001), and was unaffected by ACE inhibition in either group. PR was not increased with orthostasis in either group, but was increased after ACE inhibition in both groups (P < 0.001). MAP was not affected by orthostasis in either group, but was reduced with ACE inhibition in both groups (P < 0.01). In the tetraplegia group, MAP was initially reduced after ACE inhibition, but was maintained thereafter with increasing angles of tilt, and no subject complained of symptomatic orthostatic hypotension. Conclusion: Subjects with tetraplegia were tolerant of an acute bout of orthostatic stress after partial ACE inhibition. This may have clinical relevance because of the increased prevalence of type 2 diabetes mellitus in this population and the use of ACE inhibitors for the treatment of progressive renal and cardiovascular disease.

Original languageEnglish
Pages (from-to)103-108
Number of pages6
JournalJournal of Spinal Cord Medicine
Issue number2
StatePublished - 2005


  • ACE inhibitors
  • Blood pressure regulation
  • Orthostasis veterans
  • Spinal cord injuries
  • Tetraplegia


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