title: Which vasodilator drug in patients with chronic heart failure? A randomised comparison of captopril and hydralazine.
abstract: 1. Fifty patients with symptoms due to chronic heart failure despite diuretic therapy were randomised to receive additional treatment with either hydralazine or captopril. The dose was titrated; 24 received hydralazine and 26 captopril up to a maximum daily dosage of 225 mg and 75 mg respectively. Forty-three patients had coronary heart disease and seven dilated cardiomyopathy. 2. Dyspnoea and tiredness were assessed using a visual analogue scale (0-100) before and during 12 weeks' treatment. Captopril produced a significantly greater reduction in breathlessness (F = 31.6, P less than 0.001) and tiredness (F = 65.8, P less than 0.001) compared with hydralazine. 3. There was an increase in treadmill exercise time during treatment with both hydralazine (from 5.5 (3.47-7.53) min to 6.9 (4.87-8.93) min), and captopril (from 5.0 (3.05-6.95) min to 7.8 (5.85-9.75) min), but the degree of improvement was significantly greater in the patients treated with captopril (F = 7.4, P less than 0.001). 4. There was no significant change in right ventricular ejection fraction (from 27.9 (19.3-36.5)% to 28.7 (20.1-37.3)%) or left ventricular ejection fraction (from 22.2 (14.2-30.2)% to 23.9 (15.9-31.9)%) during treatment with hydralazine. However, both right and left ventricular ejection fraction increased significantly during treatment with captopril (from 27.1 (18.9-35.3)% to 32.0 (23.8-40.2)%, P less than 0.05; and from 25.0 (17.2-32.8)% to 29.6 (21.8-37.4)%, P less than 0.05 respectively). 5. These results suggest that in patients with symptoms due to chronic heart failure despite diuretic therapy, treatment with captopril produces a greater symptomatic and haemodynamic improvement than treatment with hydralazine.
authors.affiliation: Regional Cardiac Unit, Wythenshawe Hospital, Manchester.
authors.forename: P M
authors.initials: PM
authors.lastname: Schofield
authors.forename: N H
authors.initials: NH
authors.lastname: Brooks
authors.forename: G P
authors.initials: GP
authors.lastname: Lawrence
authors.forename: H J
authors.initials: HJ
authors.lastname: Testa
authors.forename: C
authors.initials: C
authors.lastname: Ward
mesh_terms: D000328:Adult; D000368:Aged; D002216:Captopril / Q000009:adverse effects / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy / Q000503:physiopathology; D002908:Chronic Disease; D003327:Coronary Disease / Q000188:drug therapy / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006830:Hydralazine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015635:Radionuclide Ventriculography; D011897:Random Allocation; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D006830:Hydralazine; D002216:Captopril