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Converting enzyme inhibition in coronary artery disease: a randomized, placebo-controlled trial with benazepril
P Thürmann1, H J Odenthal, N Rietbrock
1Department of Clinical Pharmacology, University Clinic Frankfurt, F.R.G.
Insights
Benazepril, a converting enzyme inhibitor (CEI), showed no significant anti-ischemic effect in patients with coronary artery disease. While plasma renin activity increased, exercise-induced ST-segment depression and angina symptoms did not improve.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) is a leading cause of morbidity and mortality.
- Converting enzyme inhibitors (CEIs) are used to manage cardiovascular conditions.
- The anti-ischemic potential of CEIs in normotensive patients with CAD requires further investigation.
Purpose of the Study:
- To evaluate the anti-ischemic efficacy of benazepril in normotensive patients with coronary artery disease.
- To assess the effects of benazepril on exercise-induced ischemia and anginal symptoms.
- To investigate the impact of benazepril on plasma renin activity (PRA) and atrial natriuretic peptide (ANP) levels.
Main Methods:
- A randomized, placebo-controlled, double-blind study with intraindividual crossover was conducted.
- 11 normotensive patients with angiographically proven CAD participated.
- Bicycle ergometry, 24-h ambulatory ECG, and measurements of PRA and ANP were performed before and after 2-week treatment periods with placebo and benazepril.
Main Results:
- Benazepril did not significantly reduce maximal exercise-induced ST-segment depression (2.09 mm vs. 1.91 mm).
- The systolic blood pressure/heart rate product at maximum workload remained unchanged.
- No significant reduction in anginal attacks or ischemic episodes was observed; however, six patients showed improvement.
Conclusions:
- Benazepril (10 mg twice daily for 2 weeks) demonstrated no significant anti-ischemic action in normotensive patients with CAD based on exercise testing.
- Benazepril significantly increased plasma renin activity but did not alter atrial natriuretic peptide levels.
- Further research may be needed to explore potential benefits in specific patient subgroups.
Abstract:
The antiischemic efficacy of the converting enzyme inhibitor (CEI) benazepril was investigated in a randomized, placebo-controlled double-blind study with intraindividual crossover in 11 normotensive patients with angiographically proven coronary artery disease. Bicycle ergometry and 24-h ambulatory ECG were performed before and after 2-week treatment with placebo and benazepril, respectively. Plasma concentrations of atrial natriuretic peptide (ANP) and plasma renin activity (PRA) were measured before each exercise test. Maximal exercise-induced ST-segment depression was not significantly influenced by benazepril therapy (placebo 2.09 +/- 1.22 mm, benazepril 1.91 +/- 1.00 mm). Systolic blood pressure/heart rate (SBP/HR) product at maximum workload remained almost constant with 253 +/- 43 with placebo and 253 +/- 39 with benazepril treatment. The number of anginal attacks and ischemic episodes detected by ambulatory ECG were not significantly reduced. PRA increased significantly from 2.18 +/- 3.76 to 9.62 +/- 8.49 ng/ml/h after benazepril (p less than 0.005), whereas plasma concentrations of ANP remained unchanged (28.04 +/- 12.39 vs. 26.73 +/- 11.09 pg/ml). Therefore, measurement of ST-segment depression with exercise in 11 normotensive patients with coronary artery disease produced no evidence of an antiischemic action for the CEI benazepril 10 mg twice daily (b.i.d.) for 2 weeks, but an improvement was observed in six patients.