Comparative analysis of the hemodynamic actions of captopril and sodium nitroprusside in severe chronic congestive heart failure.
The hemodynamic actions of the systemic vasodilators parenteral sodium nitroprusside (NP) and oral captopril (CPT) were compared in 11 patients with severe chronic congestive heart failure (CHF). While two agents produced similar reductions in mean blood pressure (NP, 90 to 70 mm Hg vs CPT, 88 to 74 mm Hg, p greater than 0.05) and left ventricular (LV) filling pressure (NP, 27 to 14 mm Hg vs CPT, 24 to 15 mm Hg, p greater than 0.05), they produce disparate effects on LV pump performance. NP raised cardiac index 35% (2.0 to 2.7 L/min/m2, p less than 0.005), whereas CPT increased this index 16% (1.9 to 2.2 L/min/m2, p less than 0.001). Concomitantly, the 31% elevation of stroke index produced by NP (26 to 34 ml/beat/m2, p less than 0.001) was greater (p less than 0.05) than the 15% rise produced by CPT (26 to 30 ml/beat/m2, p less than 0.001). Simultaneously, stroke work index showed similarly greater augmentation, and total systemic vascular resistance declined more with NP. These findings suggest that oral CPT is a predominant ventricular preload-lowering agent primarily likely to improve dyspnea related to severe pulmonary congestion in patients with advanced chronic CHF.
D002216:Captopril / Q000494:pharmacology* / Q000627:therapeutic use; D006328:Cardiac Catheterization; D005260:Female; D005292:Ferricyanides / Q000494:pharmacology*; D006333:Heart Failure / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000494:pharmacology* / Q000627:therapeutic use; D011392:Proline / Q000031:analogs & derivatives*; D014665:Vasodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use
D005292:Ferricyanides; D014665:Vasodilator Agents; D009599:Nitroprusside; D011392:Proline; D002216:Captopril