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A randomized pilot study on the effect of niacin on pulmonary arterial pressure

机译：烟酸对肺动脉压影响的随机先导研究

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Background Niacin induces the release of vasodilating prostaglandins, for which receptors are present within the pulmonary arterial circulation. We hypothesized that immediate-release niacin would reduce right ventricular systolic pressure in patients with pulmonary hypertension in a randomized, double-blinded, single-dose provocation study. Methods We recruited inpatient subjects with a Doppler echocardiogram showing a peak tricuspid regurgitation (TR) jet velocity of 2.7?m/s or greater, and who were free of known pulmonary vascular disease. Subjects were randomized in a 1:2:2 ratio to receive a single dose of either placebo, niacin 100?mg or niacin 500?mg, respectively. TR jet velocities were measured immediately before, and 1?hour post dose, corresponding to peak niacin absorption and prostaglandin release. The primary endpoint was the change in mean TR jet velocity measured over ten successive cardiac cycles. Results The baseline mean estimated right ventricular systolic pressure (RVSP) for all 49 subjects (25 male) was 51.9?±?12.1?mm Hg. The primary endpoint of mean change in TR jet velocity was 0.016?±?0.065?m/s in the placebo group, compared to ?0.017?±?0.065?m/s with niacin 100?mg, and ?0.063?±?0.038?m/s with niacin 500?mg ( P =?0.63). The change in maximum estimated RVSP across the three drug groups was 0.2?±?1.6?mm Hg, ?1.3?±?1.8?mm Hg and ?2.2?±?1.2?mm Hg ( P =?0.62). In exploratory pairwise analysis in the high-dose niacin group (500?mg), the reduction in mean RVSP was from 50.9?±?9.4?mm Hg to 48.7?±?10.0?mm Hg ( P =?0.09). Conclusions A single dose of immediate-release niacin (100?mg or 500?mg) had no significant effect on RVSP 1?hour post administration. A nonsignificant dose-dependent trend for a modest reduction in RVSP, most notable in the 500?mg group, was noted. (ISRCTN number 12353191, registered April 23, 2015).
机译：背景技术烟酸诱导血管舒张性前列腺素的释放，对此受体存在于肺动脉循环中。我们在一项随机，双盲，单剂量激发研究中假设速释烟酸可降低肺动脉高压患者的右心室收缩压。方法我们招募了多普勒超声心动图的住院患者，其三尖瓣关闭不全（TR）峰值喷射速度为2.7？m / s或更高，并且没有已知的肺血管疾病。以1：2：2的比例将受试者随机分组，分别接受单剂量的安慰剂，烟酸100？mg或烟酸500？mg。在服药前和服药后1小时测量TR射流速度，对应于烟酸吸收峰值和前列腺素释放。主要终点是连续十个心动周期测得的平均TR射流速度的变化。结果所有49名受试者（25名男性）的基线平均估计右室收缩压（RVSP）为51.9？±？12.1？mm Hg。安慰剂组TR射流速度平均变化的主要终点为0.016？±？0.065？m / s，而烟酸100？mg和？0.063？±？0.038分别为0.017？±？0.065？m / s。烟酸500？mg的？m / s（P =？0.63）。三个药物组的最大估计RVSP的变化为0.2？±？1.6？mm Hg，？1.3？±？1.8？mm Hg和？2.2？±？1.2？mm Hg（P =？0.62）。在大剂量烟酸组（500μg）的探索性成对分析中，平均RVSP的降低从50.9μg±9.4μmmHg降至48.7μg±10.0μmmHg（P = 0.09）。结论单剂立即释放烟酸（100？mg或500？mg）对RVSP给药后1小时无明显影响。注意到RVSP的适度降低没有显着的剂量依赖性趋势，在500 mg组最为明显。 （ISRCTN号12353191，2015年4月23日注册）。

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