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[Captopril versus digoxin in the treatment of mild to moderately severe heart failure]
1Medizinische Universitätsklinik, Innere Medizin-Kardiologie, Bonn.
Insights
For chronic heart failure, captopril plus hydrochlorothiazide (HCT) significantly improved patient outcomes compared to digoxin plus HCT over 12 months. This suggests ACE inhibitors with diuretics are a preferred initial treatment.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Chronic heart failure (CHF) affects millions globally, necessitating effective treatment strategies.
- Current treatment guidelines often involve diuretics, but the optimal initial combination therapy for mild to moderate CHF remains a focus of research.
Purpose of the Study:
- To compare the effectiveness of captopril plus hydrochlorothiazide (HCT) versus digoxin plus HCT in patients with chronic heart failure (NYHA classes II-III).
- To evaluate the impact of these treatment combinations on echocardiographic parameters, exercise tolerance, and New York Heart Association (NYHA) functional class over a 12-month period.
Main Methods:
- A randomized, double-blind study involving 116 patients with chronic heart failure.
- Patients received either captopril (50 mg/day) + HCT or digoxin (0.2 mg/day) + HCT for 12 months.
- A pretreatment phase of 3-4 weeks established baseline HCT dosages for both groups.
Main Results:
- The captopril/HCT group showed significantly greater improvements in echocardiographic intracardiac diameters, exercise tolerance, and NYHA class compared to the digoxin/HCT group.
- A mean improvement of one NYHA class was observed in 51.8% of patients in the captopril/HCT group versus 40.7% in the digoxin/HCT group (P < 0.01).
- No adverse events were detailed, but significant clinical improvement favored the ACE inhibitor-diuretic combination.
Conclusions:
- Initiating treatment for mild to moderately severe chronic heart failure in sinus rhythm with an angiotensin-converting enzyme (ACE) inhibitor and a diuretic is more effective than a digitalis-diuretic combination.
- These findings support the use of ACE inhibitors like captopril in combination with diuretics as a first-line therapy for CHF management.
Abstract:
In a randomized and double-blind study of 116 patients with chronic heart failure (NYHA classes II or III) the effectiveness of captopril + hydrochlorothiazide (HCT) (group 1) and of digoxin + HCT (group 2) were compared. Treatment was effected for a 12-month period with a combination of 50 mg captopril (twice 25 mg daily, oral) and HCT, or 0.2 mg digoxin (twice 0.1 mg daily, oral) and HCT. In a pretreatment phase over 3-4 weeks the patients of group 1 were given an average HCT dose of 37.7 mg daily, whereas those of group 2 received 34.9 mg per day. At the end of the 12-month treatment period the patients in the captopril/HCT group had improved significantly more--by the criteria of echocardiographic intracardiac diameters, exercise tolerance and NYHA class--than those in the digoxin/HCT group. Change by a mean of one NYHA class had occurred in 61 patients (51.8%) of group 1 and in 47 (40.7%) of group 2 (P les than 0.01). These findings suggest that treatment of patients with mild to moderately severe chronic heart failure in sinus rhythm best be initiated with an angiotensin-converting enzyme inhibitor together with a diuretic rather than a digitalis-diuretic combination.