Endothelin-1 and blood pressure after inhibition of nitric oxide synthesis in human septic shock

Background—The systemic hypotension during human sepsis has been ascribed to increased production of nitric oxide (NO). Therefore, inhibitors of NO synthesis have been used in the treatment of hypotension in patients with septic shock. In addition, NO production may inhibit the synthesis and vasoconstrictor effects of endothelin-1 (ET-1). In this study, we tested whether ET-1 contributed to the vasopressor action of the NO synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) in patients with severe septic shock. Methods and Results—Compared with healthy volunteers, patients with septic shock had increased plasma levels of nitrite/nitrate (3765 [SEM] versus 1265 mmol/L, P,0.01), the stable end products of NO metabolism, and ET-1 (4567 versus 362 pg/mL, P,0.001). Plasma ET-1 concentration was not related to plasma nitrite/nitrate concentration or blood pressure. Continuous infusion of L-NAME (1 mg z kg21 z h21 IV) for 12 hours increased mean arterial pressure by 4365 % and systemic vascular resistance by 64610 % (both P,0.01). The increase in blood pressure and systemic vascular resistance correlated positively with the level of ET-1 (both P,0.005) but not with plasma nitrite/nitrate level. L-NAME infusion did not result in significant changes in the plasma concentrations of ET-1 or nitrite/nitrate. Conclusions—NO and ET-1 may both play a role in the cardiovascular derangements of human sepsis. Although L-NAME does not increase ET-1 concentration in patients with septic shock, the vasopressor response induced by L-NAME depends on the plasma level of ET-1. These findings may indicate that inhibitors of NO synthesis unmask a tonic presso