title: Regression of left ventricular remodeling in chronic heart failure: Comparative and combined effects of captopril and carvedilol.
abstract: BACKGROUND
  This study evaluated the independent and combined effects of captopril and carvedilol on left ventricular remodeling in chronic heart failure. Although angiotensin-converting enzyme inhibitors and b-blockers are known to attenuate the remodeling process in chronic heart failure, a direct comparison of these agents has not been performed.
  
  
  METHODS
  We investigated 57 patients with mild to moderate chronic heart failure (48 ischemic, 9 nonischemic) who were randomized in a double-blind fashion to treatment with carvedilol or captopril at maximum doses of 25 mg twice daily for 3 months, followed by 3 months of combined treatment. Serial echocardiography, right heart catheterization, and treadmill exercise testing were performed at baseline, 3 months, and 6 months. After exclusions, 49 patients were evaluated during monotherapy and 48 during combination therapy.
  
  
  RESULTS
  Carvedilol monotherapy produced significant reductions in end-systolic volume, leading to a greater median increase in ejection fraction compared with captopril monotherapy (4.7% vs 1.5%, respectively; P <.05). Each drug caused similar reductions in left ventricular mass, chamber sphericity, and pulmonary artery wedge pressure during monotherapy and combined treatment. Adjunctive treatment with carvedilol produced a trend toward a greater increase in ejection fraction (4.3% vs 2.7%, respectively; P not significant) and significantly greater reductions in the wall thickening score index than with captopril (0.25 vs 0.08, respectively; P =.04).
  
  
  CONCLUSIONS
  Although angiotensin-converting enzyme inhibitor therapy did not alter left ventricular volume, treatment with carvedilol was associated with reductions in chamber volume; both drugs reduced left ventricular mass and sphericity. These beneficial effects on remodeling may help to explain the relative prognostic benefits of these therapies.
authors.affiliation: Department of Cardiovascular Medicine, Northwick Park and St Mark's Hospital National Health Service Trust, and the Institute for Medical Research, Harrow, United Kingdom.
authors.forename: R S
authors.initials: RS
authors.lastname: Khattar
authors.forename: R
authors.initials: R
authors.lastname: Senior
authors.forename: P
authors.initials: P
authors.lastname: Soman
authors.forename: R
authors.initials: R
authors.lastname: van der Does
authors.forename: A
authors.initials: A
authors.lastname: Lahiri
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D002216:Captopril / Q000494:pharmacology / Q000627:therapeutic use*; D002227:Carbazoles / Q000494:pharmacology / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D000077261:Carvedilol; D002908:Chronic Disease; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000494:pharmacology / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D002216:Captopril