Within-patient comparison of effects of different dosages of enalapril on functional capacity and neurohormone levels in patients with chronic heart failure☆,☆☆
Section snippets
Patient population
The study comprised 45 patients (43 men and 2 women) aged 33 to 74 years (mean, 55 ± 10 years) with mild-to-moderate CHF caused by coronary artery disease in 26 (58%) patients, dilated cardiomyopathy in 16 (35%) patients, and valvular heart disease in 3 (7%) patients. All patients had an ejection fraction of 40% or less (mean, 28% ± 7%) and were in stable condition for at least 3 months. ACE inhibition had been started at least 3 months before inclusion into the study. Drug therapy was
Results
The baseline characteristics are summarized in Table I.
Empty Cell E10 group (n = 16) E20 group (n = 18) E40 group (n = 11) Whole group (n = 45) Age (y) 55 ± 11 54 ± 9 57 ± 11 55 ± 10 Diagnosis CAD (n) 10 13 3 26 DCP (n) 5 5 6 16 VHD (n) 1 0 2 3 NYHA class 2.1 ± 0.4 2.1 ± 0.4 2.1 ± 0.3 2.1 ± 0.4 Systolic BP (mm Hg) 116 ± 15 114 ± 14 123 ± 17 117 ± 15 Diastolic BP (mm Hg) 68 ± 11 67 ± 10 66 ± 9 67 ± 10 Heart rate (beats/min) 72 ± 12 70 ± 12 69 ± 14 70 ± 12 Ejection fraction (%) 30.2 ± 6.7 25.8 ± 7.7 27.5 ±
Discussion
Our data show that increases in the dosage of the ACE inhibitor enalapril and the plasma level of the active metabolite enalaprilat improve functional capacity and decrease plasma levels of norepinephrine and natriuretic peptides in patients with CHF. In addition, physical signs of CHF were less on the highest, as compared with the lowest, dose and trough level. Serious adverse events tended to be less common after upward than after downward titration, and an increase to 40 mg of enalapril per
Acknowledgements
We thank B. Lüll, E. Wettstein, and S. Hyvärinen of the Division of Cardiology and M. Schlumpf of the Department of Internal Medicine for their excellent technical assistance; S. Brogli of the Institute of Clinical Chemistry for determination of natriuretic peptides; and B. Küffer of the Policlinic of Internal Medicine for determination of norepinephrine.
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Optimising management of chronic heart failure
2009, The LancetClopidogrel Is Associated With a Lesser Increase in NT-proBNP When Compared to Aspirin in Patients With Ischemic Heart Failure
2006, Journal of Cardiac FailureCitation Excerpt :Aspirin could have contributed to an accelerate rise in NT-proBNP by abolishing therapeutic effects of ACE inhibitors. ACE inhibitors dramatically decrease morbidity and mortality in patients with heart failure by slowing disease progression, which is reflected in a reduction of BNP levels.12–15 A greater increase in NT-proBNP levels in relation to aspirin therapy can therefore be explained by a vasoconstriction-related increase of ventricular filling pressures that is usually counteracted by ACE inhibitors.
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Reprint requests: H.P. Brunner-La Rocca, MD, Baker Medical Research Institute, PO Box 6492, Melbourne 8008, Victoria, Australia.
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