Captopril versus digoxin in mild-moderate chronic heart failure: a crossover study

Area of Science:

• Cardiology
• Pharmacology

Background:

• Chronic heart failure (CHF) management often involves targeting neurohormonal pathways.
• Captopril (CPT) is an angiotensin-converting enzyme inhibitor, and digoxin (D) is a cardiac glycoside, both used in heart failure treatment.

Purpose of the Study:

• To compare the effects of captopril (CPT) and digoxin (D) on cardiac function and neurohormonal markers in patients with chronic heart failure.
• To assess the impact of CPT and D on plasma renin activity (PRA), aldosterone (ALDO), noradrenaline (NA), and adrenaline (A).

Main Methods:

• A single-blind crossover study involving 16 patients with chronic heart failure (ischemic heart disease or congestive cardiomyopathy).
• Patients received placebo (PLC), CPT (25 mg t.i.d.), or D (0.25 mg once daily) in a randomized sequence for one month each, with diuretic therapy throughout.
• Measurements included plasma hormone levels (PRA, ALDO, NA, A) and exercise testing (hand grip, bicycle) at the end of each treatment period.

Main Results:

• No significant differences were observed between placebo periods.
• CPT significantly increased PRA, whereas D did not alter it.
• Both CPT and D decreased ALDO, NA, and A levels in both supine and standing positions.

Conclusions:

• Captopril and digoxin exhibit distinct effects on the renin-angiotensin-aldosterone system and sympathetic nervous system in heart failure patients.
• Both drugs effectively reduce key neurohormonal markers associated with heart failure progression.