ACE inhibitors and plasma B-type natriuretic peptide levels in elderly patients with heart failure.
BACKGROUND
Clinical trials have demonstrated the benefits of ACE inhibitors (ACEI) in the neurohormonal activity and in the functional capacity of patients with heart failure (HF), and also that these effects are dose dependent. However, since elderly individuals have been systematically excluded from the majority of these studies, the validation and incorporation of these results in the geriatric population has been questioned.


OBJECTIVE
To evaluate the effects of different doses of quinapril, an ACEI with a > 24-hour biological half-life, on plasma BNP levels, on the distance walked in the 6-minute walk test (6MWT) and on the incidence of adverse reactions in elderly individuals with systolic HF.


METHODS
A total of 30 patients (76.1 +/- 5.3 years; 15 women), in NYHA functional class II-III HF, with left ventricular EF < 40% (33.5 +/- 4.5%), on diuretics (30), digoxin (24) and nitrates (13) were included. The patients were assessed at baseline and every two months, with escalating doses of quinapril of 10, 20, 30 and 40 mg.


RESULTS
After eight months, BNP levels were 67.4% lower and the distance walked in the 6MWT was 64.9% longer in relation to baseline. Arterial hypotension with symptoms of low cerebral blood flow and/or renal dysfunction was not observed, so that the maximum quinapril dose could be used in all patients.


CONCLUSIONS
The results demonstrated the benefits of ACEI on the neurohormonal profile and functional capacity of elderly individuals with systolic HF, as well as the positive relationship between dose and effect of these drugs.
Savioli Neto
Felicio
F
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil. felicioneto@cardiol.br
Magalhães
Hélio M
HM
Batlouni
Michel
M
Piegas
Leopoldo S
LS
D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D003401:Creatine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000187:drug effects; D011446:Prospective Studies; D000077583:Quinapril; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage* / Q000009:adverse effects; D014508:Urea / Q000097:blood; D016138:Walking / Q000502:physiology*
D000806:Angiotensin-Converting Enzyme Inhibitors; D044005:Tetrahydroisoquinolines; D020097:Natriuretic Peptide, Brain; D014508:Urea; D003401:Creatine; D000077583:Quinapril