title: Beneficial effect of perindopril on cardiac sympathetic nerve activity and brain natriuretic peptide in patients with chronic heart failure: comparison with enalapril.
abstract: BACKGROUND
  In patients with chronic heart failure (CHF), it remains unclear whether perindopril is more cardioprotective than enalapril.
  
  
  RESULTS
  Forty-five stable CHF outpatients undergoing conventional therapy including enalapril therapy were randomized to 2 groups [group I (n=24): continuous enalapril treatment; group II (n=21): enalapril was changed to perindopril]. Cardiac sympathetic nerve activity was evaluated using cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and 6 months after treatment. There was no difference in baseline characteristics between the 2 groups. In group I, there were no changes in MIBG parameters, left ventricular ejection fraction (LVEF) or plasma level of brain natriuretic peptide (BNP). In contrast, in group II the delayed heart/mediastinum count ratio was significantly increased (2.0+/-0.07 vs 2.15+/-0.07, p=0.013) and the washout rate was significantly decreased (33.0+/-1.4 vs 30.5+/-1.2, p=0.030) after 6 months compared with the baseline value. In addition, LVEF was significantly increased and the plasma BNP level was significantly decreased.
  
  
  CONCLUSIONS
  These findings suggest that for the treatment of CHF, perindopril is superior to enalapril with respect of cardiac sympathetic nerve activity and BNP.
authors.affiliation: Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan. tutamoto@belle.shiga-med.ac.jp
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsutamoto
authors.forename: Toshinari
authors.initials: T
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakai
authors.forename: Keizo
authors.initials: K
authors.lastname: Nishiyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Fujii
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakae
authors.forename: Masato
authors.initials: M
authors.lastname: Ohnishi
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Wada
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
mesh_terms: D019797:3-Iodobenzylguanidine; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D002908:Chronic Disease; D004656:Enalapril / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000294:innervation; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood; D020913:Perindopril / Q000008:administration & dosage*; D011877:Radionuclide Imaging; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D007457:Iodine Radioisotopes; D020097:Natriuretic Peptide, Brain; D019797:3-Iodobenzylguanidine; D004656:Enalapril; D009638:Norepinephrine; D020913:Perindopril