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European Heart Journal 1981 2(1):75-81;
Copyright © 1981 by the European Society of Cardiology.
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© 1981, by The European Society Of Cardiology

Long-term treatment of congestive heart failure by Captopril: hemodynamic, biological and clinical effects

J. G. KAYANAKIS, J. M. FAUVEL, P. GIRAUD and J. P. BOUNHOURE

Cardiovascular Division, C.H.U. Rangueil, University of Toulouse Toulouse, France

Received 14 July 1980; revised 28 October 1980; .

Requests for reprints to: J. G. KAYANAKIS, M.D., Service de Cardiologie, Pr.J.P.Bounhoure, C.H.U. Rangueil, Chemin Vallon, 31054 Toulouse Cedex, France.

Abstract

Congestive heart failure is frequently associated with an increase in peripheral resistance induced by stimulation of the renin angiotensin system and of the sympathetic nervous system.

The clinical, biological and hemodynamic effects of Captopril (SQ 14225), an oral inhibitor of angiotensin converting enzyme, were measured in 20 patients with heart failure poorly controlled by digitalis,diuretics and vasodilator therapy.

After two months of Captopril administration from 150 to 250 mg per day, NYHA functional class improved from 34 to 206 (P<0.01). Heart rate decreased from 84.20 ± 17.46 to 76.26 ± 15.86 beats/min (mean ± standard error of the mean), (P<0.05).

Mean arterial pressure was not significantly reduced from 89.25 ± 17.21 to 82.70 ± 10.86 mm Hg. Systemic vascular resistance decreased from 2234 ± 560 to 1680 ± 381 dynes scm–5 (P<0.001), and pulmonary wedge pressure fell from 20.25 ± 7.10 to 14.60 ± 5.96 mm Hg fP<0.001). Cardiac index rose from 1.91 ± 0.41 to 2.37 ± 0.55 l/min/m2 (P<0.001) and stroke work index also increased from 23.62 ± 9.78 to 33.35 ± 14.48 g/syst/m2.

Plasma renin activity increased from 2.08 ± 2.99 to 6.73 ± 3.98 ng/mlh (P<0.001), and plasma aldosterone level fell from 21 ± 135 to 10.65 ± 4.16 ng/100 ml(P<0.01).

Clinical improvement remained stable in seven patients for more than six months. In all cases theoptimal dose did not need to be altered because of lachyphylaxis. Side effects were rare because of the lowdoses used (mean = 200 mg).

The results suggest that Captopril may be useful in the treatment of congestive heart failure.

Key Words: Refractory congestive heart failure • Captopril • long-term treatment


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