title: Clinical and neurohumoral response of patients with severe congestive heart failure treated with two different captopril dosages.
abstract: Although angiotensin converting enzyme inhibitor therapy is an established approach in the treatment of chronic heart failure, the required dosage remains unclear. This open 6 month study investigated the influence of different captopril dosages on the clinical course and neurohumoral activity of patients with severe heart failure (left ventricular ejection fraction < or = 20%). Eighty-five patients in New York Heart Association class II-IV despite treatment with digitalis, diuretics, and captopril (mean dose +/- SEM 28 +/- 2 mg.day-1 at baseline) for > or = 3 months received either 'low dose' captopril (< 75 mg.day-1, mean 32 +/- 2 mg.day-1; n = 46) or 'high dose' captopril (> or = 75 mg.day-1, mean 99 +/- 4 mg.day-1; n = 39) during the follow-up period. Both groups were comparable in clinical, haemodynamic and neurohumoral parameters at baseline. Functional state improved significantly only in the high dose group (P < 0.0001). Of 31 low dose and 20 high dose patients considered as heart transplantation candidates at baseline, 21 low dose and only six high dose patients remained on the waiting list (P < 0.0001). In patients in the low dose group, eight deaths were observed (P < 0.001). Seven patients remained on low dose captopril due to adverse effects. The initially elevated plasma levels of aldosterone and atrial natriuretic peptide decreased significantly only in high dose patients (P < 0.01). Renin increased significantly in both groups. These observations underline the necessity of suppressing neurohumoral overactivation with adequate doses of captopril reflected by sequential humoral plasma determination.
authors.affiliation: Department of Cardiology, University of Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Pacher
authors.forename: S
authors.initials: S
authors.lastname: Globits
authors.forename: J
authors.initials: J
authors.lastname: Bergler-Klein
authors.forename: H
authors.initials: H
authors.lastname: Teufelsbauer
authors.forename: M
authors.initials: M
authors.lastname: Wutte
authors.forename: W
authors.initials: W
authors.lastname: Baumgartner
authors.forename: E
authors.initials: E
authors.lastname: Ogris
authors.forename: D
authors.initials: D
authors.lastname: Glogar
mesh_terms: D000450:Aldosterone / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000097:blood; D002216:Captopril / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D002216:Captopril; D012083:Renin