Symptomatic Assessment of Patients With Heart Failure: Double-Blind Comparison of Increasing Doses of Diuretics and Captopril in Moderate Heart Failure

Cowley, A. J.; Wynne, R. D.; Stainer, K.; Rowley, J M; Hampton, John R.

doi:10.1016/s0140-6736(86)90298-9

Cited by 83 publications

(22 citation statements)

References 6 publications

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“…Captopril, an angiotensin converting enzyme inhibitor, produces haemodynamic and clinical benefits in patients with severe heart failure LeJemtel et al, 1982;Captopril Multicenter Research Group, 1983;Kramer et al 1983) but has not been shown to have established benefit over digoxin or diuretics in mild heart failure (Alicandri et al, 1986;Cowley et al, 1986;Magnani et al, 1986;The CaptoprilDigoxin Multicenter Research Group, 1988). Our own study compared captopril and ISDN as adjunctive treatment over 3 months in patients with mild heart failure already maintained on digoxin and diuretics.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies in mild heart failure have compared captopril treatment with placebo, digoxin or increased diuretic dosage (Alicandri et al, 1986;Cowley et al, 1986;Magnani et al, 1986;The Captopril-Digoxin Multicenter Research Group, 1988), and have shown captopril to improve exercise tolerance and functional class but not ejection fraction. When improved ejection fraction has been shown, the absolute increase has been small (2%) (Gronda et al, 1986).…”

Section: Discussionmentioning

confidence: 99%

“…The benefits of captopril in mild heart failure and advantages over increased diuretic dosage have been less well defined with few long-term studies, no comparison with other vasodilators and no comparison of dosage frequency (Alicandri et al, 1986;Cowley et al, 1986;Magnani et al, 1986;Captopril-Digoxin Multicenter Research Group, 1988).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the immediate and long‐term effects of captopril and isosorbide dinitrate as adjunctive treatment in mild heart failure.

Wilkes

Barin

Hoschl

et al. 1989

Brit J Clinical Pharma

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1. The efficacy of captopril and isosorbide dinitrate (ISDN) as adjunctive therapy to digoxin and diuretics in mild heart failure was compared in a double‐blind study. 2. Twenty‐one patients were randomly allocated to captopril (twice or three times daily) or ISDN. Eighteen patients completed a protocol of placebo run‐in, dose titration and maintenance treatment for 3 months. 3. Symptom‐limited exercise tolerance, ejection fraction and radionuclide indices of diastolic function estimated by gated blood pool scan did not change with either treatment. 4. Captopril improved functional class (Canadian Cardiovascular Society) and reduced requirements for increased diuretic dosage at both 1 and 3 months of maintenance treatment. Patients treated with ISDN required increased diuretic and did not improve their functional class. Differences between the treatments were significant only for diuretic dosage requirements. 5. We conclude that adjunctive therapy of mild heart failure with captopril administered twice daily provides a diuretic‐sparing effect and may improve functional class during 3 months of maintenance treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of the immediate and long‐term effects of captopril and isosorbide dinitrate as adjunctive treatment in mild heart failure.

Wilkes

Barin

Hoschl

et al. 1989

Brit J Clinical Pharma

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“…This added underperfusion that affects the muscles of the limbs during physical effort is an immediate determinant of fatigue. 27 Resting and exercise local underperfusion and the systemic functional shifts that occur in CHF would account for the muscle waste and for the microanatomical, biochemical and functional unfavourable changes undergone by skeletal muscle in CHF. These changes would constitute the basis of the development of fatigue when physical activity augments relative underperfusion.…”

Section: Introductionmentioning

confidence: 99%

“…These favourable changes result in an important reduction in dyspnoea and in a small decrease in fatigue, and therefore in an increase in the capacity to perform physical activity. 27 In the medium range, increased physical activity, particularly if it includes exercise training, would improve the structure and function of skeletal muscle [29][30][31][32][33] and would reduce excess ventilation, [33][34][35][36] thereby mitigating dyspnoea and fatigue further.…”

Section: Introductionmentioning

confidence: 99%

Diuretics in the treatment of patients who present congestive heart failure and hypertension

Reyes¹

2002

J Hum Hypertens

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The main operational objective of diuretic therapy in patients who present congestive heart failure and hypertension is to reduce or to suppress excess bodily fluid. Effective diuretic therapy decreases cardiac size when the heart is dilated, and it reduces lung congestion and excess water. Consequently, external respiratory work diminishes and cardiac output would be redistributed in favour of systemic vascular beds other than that of the respiratory muscles; dyspnoea decreases markedly and there is a slight reduction in fatigue. This clinical improvement and the fall in body weight caused by diuretics entail an increase in effort capacity. Subsequent exercise training ameliorates the abnormal ventilatory response to physical effort and the skeletal muscle myopathy that occur in heart failure, and thereby it attenuates dyspnoea and decreases fatigue further. Loop and/or thiazide-type diuretics may be used to aug-

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Comparative Effects of Therapy With Captopril and Digoxin in Patients With Mild to Moderate Heart Failure

Cohn¹,

Hawkins²,

Levine³

et al. 1988

JAMA

490

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This multicenter, double-blind, placebo-controlled study compares the effects of captopril treatment with those of digoxin treatment during maintenance diuretic therapy in patients with mild to moderate heart failure. Compared with placebo, captopril therapy resulted in significantly improved exercise time (mean increase, 82 s vs 35 s) and improved New York Heart Association class (41% vs 22%), but digoxin therapy did not. Digoxin treatment increased ejection fraction (4.4% increase) compared with captopril therapy (1.8% increase) and placebo (0.9% increase). The number of ventricular premature beats decreased 45% in the captopril group and increased 4% in the digoxin group in patients with more than ten ventricular premature beats per hour. Treatment failures, increased

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Symptomatic Assessment of Patients With Heart Failure: Double-Blind Comparison of Increasing Doses of Diuretics and Captopril in Moderate Heart Failure

Cited by 83 publications

References 6 publications

Comparison of the immediate and long‐term effects of captopril and isosorbide dinitrate as adjunctive treatment in mild heart failure.

Comparison of the immediate and long‐term effects of captopril and isosorbide dinitrate as adjunctive treatment in mild heart failure.

Diuretics in the treatment of patients who present congestive heart failure and hypertension

Comparative Effects of Therapy With Captopril and Digoxin in Patients With Mild to Moderate Heart Failure

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