Hemodynamic Results of Perorally Administered Converting Enzme Inhibitors in Congestive Heart Failure

Abstract

The acute hemodynamic response to captopril (8 patients) and enalapril (8 patients) was evaluated in congestive heart failure patients in NYHA functional class III. All patients had a history of congestive heart failure for more than six months. The results show marked interindividual variations but average values for cardiac output increase and decrease in filling pressures agree with findings in the literature. 6 patients in the captopril group and five in the enalapril group were started on maintenance therapy. One patient in the captopril group deteriorated and underwent a successful heart transplantation and one patient in the enalapril group returned with arrhytmias and hypertension (probably not drug-related) after 48 h of therapy. Our data indicate that activation of the renin-angiotensin system through excessive administration of loop-diuretics is associated with a risk of hypovolemia and thus drug-induced hypotension that deserves special attention when considering converting enzyme inhibitor therapy in congestive heart failure.

Tissue and plasma angiotensin converting enzyme and the response to ACE inhibitor drugs.

“…Hyperreninaemia has been implicated as the whole explanation for the magnitude of first dose response (Cody, 1984;Dzau, 1989;Kubo et al, 1987;Packer et al, 1985b). However individual patterns of the response, where presented in detail, frequently show a sudden collapse in blood pressure (Cleland et al, 1985a,b;Lantz et al, 1984) rather than a progressive but exaggerated response. The relationship of these events to drug accumulation has not been documented and indeed only very recently has a placebo controlled trial of the initial response to ACE inhibitor therapy in chronic cardiac failure been published (Herrlin et al, 1990).…”

The response to the first dose of an angiotensin converting enzyme inhibitor in uncomplicated hypertension‐a placebo controlled study utilising ambulatory blood pressure recording.

“…The use of increasingly recognised as effective antihypertensive ACE inhibitors in severe hypertension associated with drugs regardless of age, sex or plasma renin activity renal diseases (Johnston, 1988) and in chronic cardiac (Williams, 1988). Early studies with these drugs used failure was reported to be associated with marked first high doses and this was associated with a spectrum of dose hypotension with concomitant organ hypoCorrespondence: Dr R. J. MacFadyen, University Department of Medicine and Therapeutics, Western Infirmary, Glasgow Gll 6NT perfusion damage (Cleland et al, 1985;LaBarre et al, 1982;Lantz et al, 1984;Mujais et al, 1984). Although attempts have been made to define factors predicting such responses (Hodsman et al, 1983) there is no good discriminant of predisposition to a marked hypotensive response.…”