Effect of oral captopril on premature ventricular complexes in patients with preserved left ventricular systolic function: A randomized clinical trial

Abstract

Summary: Some studies have suggested that angiotensinconverting enzyme (ACE) inhibition in patients with heart failure is associated with a decrease in frequency of spontaneous premature ventricular complexes (PVCs). It is not clear whether such a finding represents a primary effect of ACE inhibition or, instead, a secondary result of treatment of heart failure. For a primary drug effect to be present, PVC suppression during ACE inhibition should also occur in patients with preserved left ventricular systolic function. We therefore undertook a randomized double-blind placebo-controlled crossover clinical trial to assess the effect of oral captopril(50 mg. bid.) on ventricular arrhythmia frequency in 11 patients with > 30 PVCs/h (during a 48-h ambulatory recording) and a left ventricular ejection fraction of 2 45% (measured by radionuclide multigated acquisition scan). Pharmacologic activity of the administered drug was evidenced by an increase in median plasma renin activity to 2.4 ng/AymVh from a value of 1.1 ng/AI/nVh during placebo (p = 0.001) and an 8.5 f 10.3 drop in mean diastolic blood pressure during captopril versus placebo (p < 0.03).