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Hemodynamic effects of captopril in chronic heart failure efficacy of low dose treatment and comparison with prazosin


, : Hemodynamic effects of captopril in chronic heart failure efficacy of low dose treatment and comparison with prazosin. American Heart Journal 104(5 PART 2): 1164-1171

The acute hemodynamic effects and long-term therapeutic actions of low doses of the oral angiotensin-converting enzyme (ACE) inhibitor captopril (CPT) were evaluated in 18 patients with severe chronic congestive heart failure (CHF). Increasing doses of 1, 2.5, 6.25, 12.5 and 25 mg of CPT were given at 2-h intervals. Increased stroke volume index (SVI) and reduced mean pulmonary capillary wedge (PCW) pressure occurred at 1 h (P < 0.05) with an associated decline of blood pressure. Maximal hemodynamic improvement for the group was seen at 6 and 7 h following the 6.25 and 12.5 mg doses when SVI was elevated 35% and mean PCW pressure decreased 40% from control. CPT 12.5-50 mg every 8 h was continued long term in these 18 CHF patients. Four patients died, and 1 was noncompliant; drug therapy was withdrawn in 2 patients with symptomatic hypertension and in 1 patient who experienced an alteration in taste. The remaining 10 patients showed significant improvement in symptoms and treadmill exercise duration at 3 mo. after CPT therapy was started. Repeat hemodynamic measurements were similar to optimal measurements obtained during the initial study. In a further study, the acute hemodynamic and hormonal effects of sequentially randomized 5 mg prazosin and 25 mg CPT were compared in 10 CHF patients. While both drugs reduced PCW pressure and vascular resistance, CPT effects were greater. CPT alone effected a small rise in cardiac index and minor decline in heart rate, and CPT diminished aldosterone levels and increased plasma renin activity while prazosin did not.

US$29.90

PMID: 6291361


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