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ACE inhibitors and plasma B-type natriuretic peptide levels in elderly patients with heart failure
Felicio Savioli Neto1, Hélio M Magalhães, Michel Batlouni
1Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil. felicioneto@cardiol.br
Insights
This study shows that higher doses of quinapril (an ACE inhibitor) significantly improve heart failure symptoms and exercise capacity in elderly patients. The drug was well-tolerated, demonstrating a clear dose-dependent benefit for this population.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Clinical trials show Angiotensin-Converting Enzyme Inhibitors (ACEI) benefit heart failure (HF) patients, but elderly individuals were often excluded.
- The efficacy and safety of ACEI in the geriatric population with HF remain a concern.
Purpose of the Study:
- To assess the effects of escalating quinapril doses on B-type Natriuretic Peptide (BNP) levels and 6-minute walk test (6MWT) distance in elderly patients with systolic HF.
- To evaluate the incidence of adverse reactions to quinapril in this demographic.
Main Methods:
- Thirty elderly patients (mean age 76.1 years) with NYHA class II-III systolic HF and LVEF < 40% were enrolled.
- Patients received escalating doses of quinapril (10, 20, 30, 40 mg) over eight months, with assessments every two months.
Main Results:
- BNP levels decreased by 67.4% and 6MWT distance increased by 64.9% from baseline.
- No cases of symptomatic arterial hypotension or renal dysfunction were observed, allowing all patients to reach the maximum quinapril dose.
Conclusions:
- ACE inhibitors like quinapril are beneficial for the neurohormonal profile and functional capacity of elderly patients with systolic HF.
- A positive dose-response relationship exists for quinapril in this population, with good tolerability.
Background:
Clinical trials have demonstrated the benefits of ACE inhibitors (ACEI) in the neurohormonal activity and in the functional capacity of patients with heart failure (HF), and also that these effects are dose dependent. However, since elderly individuals have been systematically excluded from the majority of these studies, the validation and incorporation of these results in the geriatric population has been questioned.
Objective:
To evaluate the effects of different doses of quinapril, an ACEI with a > 24-hour biological half-life, on plasma BNP levels, on the distance walked in the 6-minute walk test (6MWT) and on the incidence of adverse reactions in elderly individuals with systolic HF.
Methods:
A total of 30 patients (76.1 +/- 5.3 years; 15 women), in NYHA functional class II-III HF, with left ventricular EF < 40% (33.5 +/- 4.5%), on diuretics (30), digoxin (24) and nitrates (13) were included. The patients were assessed at baseline and every two months, with escalating doses of quinapril of 10, 20, 30 and 40 mg.
Results:
After eight months, BNP levels were 67.4% lower and the distance walked in the 6MWT was 64.9% longer in relation to baseline. Arterial hypotension with symptoms of low cerebral blood flow and/or renal dysfunction was not observed, so that the maximum quinapril dose could be used in all patients.
Conclusion:
The results demonstrated the benefits of ACEI on the neurohormonal profile and functional capacity of elderly individuals with systolic HF, as well as the positive relationship between dose and effect of these drugs.
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