Quantification of Exercise Tolerance in Congestive Heart Failure and Role of Ace Inhibitors

Abstract

A prospective randomised controlled trial with captopril/enalapril was carried out on 25 patients with congestive heart failure (CHF) of various aetiologies in NYHA Class II & III to study the effect of Ace inhibitors on exercise tolerance. The control group (Gp-A) comprising of 12 patients received conventional treatment (digitalis and diuretics) and the test group (Gp-B) with 13 patients were in addition given captopril/enalapril as tolerated. They were followed up for a mean period of 101.6+50.6 days (approx 3 months). Ten patients from each group could complete the study. The exercise testing was done on treadmill using a suitable protocol and end-points, at the beginning and end of study. None of the clinical and noninvasive parameters showed significant difference, however the mean exercise duration in Group A improved from 7.84+3.34 to 9.2 +3.16 minute (P <0.05) and in Group B increased from 7.91+4.6 to 10. 92+4.66 minute (p < 0.001). On comparing the benefits of the two groups the difference was statistically significant (P < 0.05).lt is concluded that Ace inhibitor improves the exercise tolerance in CHF and the benefit is evident despite any improvement in clinical and noninvasive indices of left ventricular function. MJAFI 1998; 54: 331-334

Cardiovascular Effects and Enjoyment of Exercise Gaming in Older Adults

“…Perceived exertion combines both the subjective intensity perceptions of heart rate and blood pressures in those who take cardiovascular medication during exercise to provide a personal intensity level to train to instead of using a target heart rate based on age (Dunbar, Glickman-Weiss, Edwards, Conley, & Quiroz, 1996;Squires, 2011). Overall, older adults who have blood pressure controlled on anti-hypertensive therapies (i.e., diuretics, ACE, ARB, CCB or BB) were shown to tolerate exercise without excessive fatigue or lack of endurance compared to normotensive older adults (de Vries et al, 1995;Dunselman, 2001;Finimundi, Caramori, & Parker, 2007;Hasija, Karloopia, Shahi, & Chauhan, 1998;Parthasarathy et al, 2009;Poelzl et al, 2006;Riegger, 1991).…”

Neurohormonal Intervention to Reduce Sudden Cardiac Death in Heart Failure: What is the Optimal Pharmacologic Strategy?

“…Use of ACE inhibitors has been shown to reduce the incidence of atrial fibrillation both experimentally [27] and in patients with LVD post-MI [28]. However, while ACE inhibitors have been shown to reduce QT interval dispersion [29,30], a predictor of SCD in HF [30], evidence for reduction of ventricular arrhythmias is relatively limited and requires substantiation [31][32][33]. There is clear evidence for an overall mortality benefit using ACE inhibitors in patients with HF [34,35].…”