ACE inhibitors and heart failure

Cleland, Jennifer; Yiannakou, J. Y.; Gray, KennethE.; Winter, R.; Ball, Stephen G.; Julian, Desmond G.; Elder, Andrew; Flapan, A. D.

doi:10.1016/0140-6736(92)90855-w

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…This may be especially dangerous in patients with heart failure. The incidence of syncope following initiation of an ACE inhibitor appears to have decreased dramatically over the last decade to between 0.5 and 2.2 %, although this may reflect changes in reporting practices 9,10 . Many clinicians continue to monitor closely the response to the first dose of an ACE inhibitor in patients with grade 3 or 4 heart failure (NYHA criteria) and in those who present low BP.…”

Section: Symptoms Of First-dose Hypotensionmentioning

confidence: 99%

“…However, in susceptible individuals, particularly the elderly and those with heart failure, first-dose hypotension can be profound and the clinical consequences can be more dangerous. Severe hypotension is not infrequently associated with cardiac, renal and neurological complications, and occasionally death 9 . Mets and colleagues reported that administration of a first dose of captopril (6.25 mg) in 97 elderly patients (mean age 84 years) with chronic heart failure resulted in systolic blood pressure (BP) being reduced by 15 % (generally within 60 minutes) in 54 % of recipients 11 .…”

Section: Clinical Consequencesmentioning

confidence: 99%

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Heart Failure and First Dose Hypotension After Angiotensin Converting Enzyme Inhibitors

Vítovec¹,

Špinar²

2004

BIOMED PAP

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The first-dose induced decrease in blood pressure in some patients following the administration of ACE inhibitors is a fact causing some concern among clinicians prescribing these drugs. However, an overview of clinical trials and the authors' own experience clearly point to the possibility of reducing the incidence and/or severity of first-dose hypotension. Apart from appropriate clinical measures to be taken, the choice of the ACE inhibitor seems to be of crucial importance as some (fosinopril, perindopril) produce less hypotension than others. Thus, with due circumspection, ACE inhibitors can safely retain their position as the cornerstone of the treatment of chronic heart failure.First-dose hypotension has been recognized as a potential limiting factor in the use of ACE inhibitors in the treatment of chronic heart failure (CHF) and after acute myocardial infarction (AMI). Concerns regarding firstdose hypotension may increase the risk of renal, myocardial, or cerebral hypoperfusion that may result. The incidence of first-dose hypotension after ACE inhibitors reported in large clinical trials is small, varying from 0.7 % in the SAVE trial to 13.3 % in the OPTIMAAL trial 1,2 . This variation reflects differences in study design, in patient selection, in the definition of first-dose hypotension, and in drug selection. The major reason for the low number of these events reported is a very infrequent use of ambulatory blood pressure monitoring, and thus the incidence of less than 10 % reflects only symptomatic or casually measured hypotension. A number of smaller trials have reported a much higher incidence of first-dose hypotension, affecting as many as one third of the patients. SYMPTOMS OF FIRST-DOSE HYPOTENSIONThe most frequently reported symptoms of drug-induced hypotension are those related to cerebral hypoperfusion. These include light headiness, dizziness, headache, general weakness and visual disturbances 3 . In elderly patients, drug-induced hypotension has also been associated with falling. Several studies conducted in the community and in long-term residential care facilities have found drug-induced hypotension to be the primary cause of falling in both fit and frail elderly patients [4][5][6] . The clinical consequences of first-dose hypotension assume particular relevance in this patient population because the compensatory circulatory response to hypotensive stimuli, pre-existing vascular disease or both declines with age 7,34 . With more severe first-dose hypotension, the subsequent drop in cerebral blood flow can lead to a sudden brief loss of consciousness (syncope), often accompanied by bradycardia 8 . This may be especially dangerous in patients with heart failure. The incidence of syncope following initiation of an ACE inhibitor appears to have decreased dramatically over the last decade to between 0.5 and 2.2 %, although this may reflect changes in reporting practices 9,10 . Many clinicians continue to monitor closely the response to the first dose of an ACE inhibitor in patients with grade 3 ...

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Section: Symptoms Of First-dose Hypotensionmentioning

confidence: 99%

Section: Clinical Consequencesmentioning

confidence: 99%

Heart Failure and First Dose Hypotension After Angiotensin Converting Enzyme Inhibitors

Vítovec¹,

Špinar²

2004

BIOMED PAP

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Stability of plasma concentrations of N and C terminal atrial natriuretic peptides at room temperature.

Cleland

Ward

Dutka

et al. 1996

Heart

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Background-Plasma concentrations of atrial natriuretic peptide (ANP) are increased in patients with ventricular dysfunction and could have a diagnostic role in heart failure. ANP may be unstable after collection, however, limiting any practical diagnostic role. Methods-Blood samples were obtained from 18 patients with various conditions. Aliquots were either processed optimally or kept as blood or plasma at room temperature for 6-72 h before processing. Results-Concentrations of C-terminal ANP were lower in specimens kept as blood for 24 and 72 h (mean difference from control -43% and -76%, respectively, (P < 0.001) but N-terminal ANP (extracted) seemed to be stable under all conditions studied (-2% at 24 h and -7% at 72 h, not significant). Conclusions-N-terminal ANP (extracted) is stable and potentially has a role in the diagnosis of heart failure in routine clinical practice. (Heart 1996;75:410-413)

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Coronary artery disease, valvular heart disease, bradycardia, and heart failure

Smith

Powell

Hastie

1995

Postgraduate Medical Journal

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Medicine in the elderlyCoronary artery disease, valvular heart disease, bradycardia, and heart failure E Smith, H Powell, IR Hastie Case historyThe patient is a 76-year-old man with a long history of stable angina having increasing frequency of pain at rest. Despite medical treatment he had ongoing rest pain and ECG evidence of ischaemia (figure 1). Emergency coronary arteriography was performed (figure 2) and he had emergency surgery, undergoing quadruple grafting using combined arterial and saphenous vein conduits. The procedure and post-operative course were uncomplicated and he returned home seven days later.Box 1

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ACE inhibitors and heart failure

Cited by 3 publications

References 9 publications

Heart Failure and First Dose Hypotension After Angiotensin Converting Enzyme Inhibitors

Heart Failure and First Dose Hypotension After Angiotensin Converting Enzyme Inhibitors

Stability of plasma concentrations of N and C terminal atrial natriuretic peptides at room temperature.

Coronary artery disease, valvular heart disease, bradycardia, and heart failure

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