Sustained haemodynamic and clinical effects of captopril in long‐term treatment of severe chronic congestive heart failure.

Abstract

1 The angiotensin‐converting‐enzyme inhibitor captopril is known to produce beneficial haemodynamic effects in patients with chronic congestive heart failure. 2 Twelve patients with chronic congestive heart failure were conventionally treated with digitalis and diuretic therapy plus oral captopril (75‐150 mg/day), and 14 patients were used as a control group. 3 There was no improvement in functional and haemodynamic values in the controls, but the patients treated with captopril showed a significant functional improvement (increase of exercise time and improvement in New York Heart Association functional class), a definitive decrease in systemic vascular resistance (20%), and a significant increase in the cardiac index and ejection fraction (18% and 28% respectively).

Recovery From Left Ventricular Dysfunction

“…The authors report an increase in baseline LVEF from 29.7% ± 7.5% to 38% ± 10.6% with 6 months of captopril therapy. 11 The next piece of evidence in support of widespread ACEi therapy in HFrEF came from the Studies of Left Ventricular Dysfunction (SOLVD) group trials. A 1991 study of HFrEF patients, with ~90% of participants in NYHA class II and III, showed a 16% risk reduction in mortality with enalapril treatment, and notably, the most significant decrease in mortality was seen in deaths from progressive HF (RR = 22%).…”

“…The authors report an increase in baseline LVEF from 29.7% ± 7.5% to 38% ± 10.6% with 6 months of captopril therapy. 11…”

“…17 Interestingly, after the 48 weeks of therapy, no significant change in LVEF was seen in either group, as opposed to the data mentioned above, which did show an increase in LVEF after 6 months of treatment with captopril. 11 The subsequent Heart Failure Endpoint Evaluation of Angiotensin II Antagonist Losartan (HEAAL) study looked at the impact of increasing the dose of losartan from the 50 mg dose studied in ELITE and ELITE II to losartan 150 mg in patients with LVEF who were intolerant to ACEi and found that the higher dose group had a significant reduction in the primary endpoint of mortality or HF hospitalization, with a more substantial impact on rates of HF hospitalization than mortality. 18 This may indicate that the ventricular function substudy of the ELITE patients treated with the lower dose may not reflect the potential for LV functional recovery that this drug has at higher doses.…”