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Chronic therapy for congestive heart failure with benazepril HCl, a new angiotensin converting enzyme inhibitor
D M Mirvis1, J Insel, M J Boland
1Veterans Administration Medical Center, Memphis, TN.
Insights
Benazepril HCl effectively treats advanced congestive heart failure with once-daily oral doses. This angiotensin converting enzyme (ACE) inhibitor improves hemodynamics and reduces symptoms like dyspnea and edema, demonstrating chronic therapeutic value.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) is a debilitating condition requiring effective long-term management.
- Angiotensin converting enzyme (ACE) inhibitors have demonstrated acute hemodynamic benefits in CHF patients.
Purpose of the Study:
- To evaluate the chronic clinical and hemodynamic efficacy of benazepril HCl in advanced congestive heart failure.
- To assess the safety and tolerability of daily oral benazepril HCl administration.
Main Methods:
- A 28-day open-label study involving 21 patients with New York Heart Association Class III or IV CHF.
- Administration of 2-15 mg of benazepril HCl as a single daily oral dose.
- Invasive hemodynamic monitoring on days 1-2 and 27-28, alongside clinical evaluations and plasma biomarker analysis.
Main Results:
- Significant reductions in arterial pressure and systemic vascular resistance (p < 0.01).
- Significant increases in cardiac output and decreases in pulmonary artery wedge pressure.
- Sustained hemodynamic improvements and notable reductions in dyspnea and peripheral edema. Plasma ACE activity and aldosterone decreased, while renin increased.
Conclusions:
- Once-daily benazepril HCl is an effective and well-tolerated oral therapy for chronic management of advanced congestive heart failure.
- The drug demonstrates sustained clinical and hemodynamic benefits over 28 days of treatment.
- Benazepril HCl offers a valuable therapeutic option for patients with severe CHF.
Abstract:
Benazepril HCl is an orally effective angiotensin converting enzyme (ACE) inhibitor previously shown to have significant acute hemodynamic benefits in patients with congestive heart failure. In this study, 21 patients with New York Heart Association Class III or IV congestive heart failure were treated with 2 to 15 mg of benazepril HCl as a single daily oral dose for 28 days to determine the clinical and hemodynamic value of chronic therapy. Each patient underwent clinical evaluation during the 28-day period, as well as invasive hemodynamic studies on the first two and last two days of the trial. Plasma ACE activity and aldosterone levels fell significantly and renin levels rose after therapy. Benazepril HCl produced significant (p less than 0.01) reductions in arterial pressure and systemic vascular resistance, with corresponding increases in cardiac output and decreases in pulmonary artery wedge pressure. Responses after 28 days of therapy were equivalent to those after the initial doses. Clinical effects included reduced rest, exertional and paroxysmal nocturnal dyspnea, as well as reduced peripheral edema. Only one patient developed symptomatic orthostatic hypotension. Thus, benazepril HCl, given once daily, is an effective and well tolerated oral agent for the chronic treatment of advanced congestive heart failure.