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Captopril versus digoxin in mild-moderate chronic heart failure: a crossover study
Insights
Captopril (CPT) and digoxin (D) both reduced aldosterone, noradrenaline, and adrenaline in heart failure patients. CPT increased plasma renin activity, while D did not, indicating different neurohormonal effects.
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.
Abstract:
The effects on cardiac function of captopril (CPT) and digoxin (D) were compared in a study of 16 patients with chronic heart failure due to ischemic heart disease (15) and to congestive cardiomyopathy (1) (New York Heart Association class II n.13 and class III n.3). All patients were normotensive and in sinus rhythm. CPT 25 mg every 8 hours (t.i.d.) or D 0.25 mg once daily was given in a single-blind crossover design: A placebo (PLC) t.i.d. was given for 5 to 10 days, then CPT or D, according to a random sequence, replaced three or one of the PLC tablets; after one month, CPT and D were switched to PLC for 5 to 10 days; subsequently, the PLC tablets were replaced by CPT in the patients who previously received D and vice versa, and both treatments were again continued for one month. PLC, CPT, and D tablets were all identical. Diuretics once daily were given throughout the study. Plasma renin activity (PRA), plasma aldosterone (ALDO), plasma noradrenaline (NA), and adrenaline (A) were determined at the end of the two PLC periods and the two active treatments. A hand grip and a bicycle exercise were performed at the end of the two PLC periods and the two active treatments. No difference was noted between the PLC periods. PRA increased with CPT and did not change with D. ALDO was decreased by both CPT and D. NA and A were similarly decreased by both drugs, both supine and standing.(ABSTRACT TRUNCATED AT 250 WORDS)