Beneficial effect of perindopril on cardiac sympathetic nerve activity and brain natriuretic peptide in patients with chronic heart failure: comparison with enalapril.
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.
Tsutamoto
Takayoshi
T
Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan. tutamoto@belle.shiga-med.ac.jp
Tanaka
Toshinari
T
Sakai
Hiroshi
H
Nishiyama
Keizo
K
Fujii
Masanori
M
Yamamoto
Takashi
T
Nakae
Ichiro
I
Ohnishi
Masato
M
Wada
Atsuyuki
A
Horie
Minoru
M
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
D000806:Angiotensin-Converting Enzyme Inhibitors; D007457:Iodine Radioisotopes; D020097:Natriuretic Peptide, Brain; D019797:3-Iodobenzylguanidine; D004656:Enalapril; D009638:Norepinephrine; D020913:Perindopril