title: Angiotensin converting enzyme inhibitors in congestive heart failure. Overview in comparison of captopril and enalapril.
abstract: In this study, the use of enalapril and captopril is compared in the treatment of congestive heart failure. Although both drugs act on the renin-angiotensin system via converting enzyme inhibition, their different chemical structures may dispose them to different pharmacologic and physiologic activity. Both drugs exert a vasodilator effect, with reduction of left and right ventricular filling pressures and aortic impedance. In short-term hemodynamic studies, the onset of action and peak effect are earlier with captopril. Enalapril has a much more gradual onset and longer duration of action. Both drugs have a shallow dose-response curve and both produce comparable hormonal changes: an increase in plasma renin activity and a decrease in aldosterone levels. Captopril also increases prostaglandin production. Long-term efficacy trials have demonstrated symptomatic improvement in patients given captopril and those receiving enalapril who were also receiving digitalis and diuretics. Baseline hemodynamics may not predict long-term improvement. There are few adverse effects for the two drugs, but their incidences differ, suggesting a relationship to chemical structure. Recent studies in congestive heart failure suggest a reduction in mortality with various drug regimens.
mesh_terms: D000450:Aldosterone / Q000378:metabolism; D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril / Q000627:therapeutic use*; D004656:Enalapril / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D012083:Renin / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects; D013810:Therapeutic Equivalency; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000450:Aldosterone; D004656:Enalapril; D002216:Captopril; D012083:Renin