Related Experiment Videos
[Comparison of captopril with enalapril in the therapy of heart failure: effect on hemodynamics and kidney function]
K J Osterziel1, R Dietz, K Mikulaschek
1Innere Medizin III, (Schwerpunkt Kardiologie, Angiologie und Pulmonologie), Medizinische Universitätsklinik Heidelberg.
Insights
Captopril and enalapril, both angiotensin converting enzyme (ACE) inhibitors, similarly improved hemodynamics in severe heart failure patients. Neither drug significantly altered renal function or electrolytes.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Severe heart failure (NYHA III) significantly impacts patient hemodynamics and renal function.
- Angiotensin converting enzyme (ACE) inhibitors are a cornerstone therapy for heart failure.
Purpose of the Study:
- To compare the hemodynamic and renal effects of captopril and enalapril in patients with severe heart failure.
- To evaluate the efficacy of two different ACE inhibitors in managing advanced heart failure.
Main Methods:
- Randomized assignment of 24 severe heart failure patients to captopril or enalapril therapy.
- Evaluation of hemodynamic parameters (mean arterial pressure, heart rate, stroke volume index) and renal function (serum creatinine, electrolytes) after a mean of 9 days.
Main Results:
- Both captopril and enalapril significantly reduced mean arterial pressure and increased stroke volume index without significant inter-group differences.
- Heart rate decreased similarly in both groups, with statistical significance only in the enalapril group.
- No significant changes in serum electrolytes or creatinine were observed with either ACE inhibitor therapy.
Conclusions:
- Captopril and enalapril demonstrate comparable efficacy in improving hemodynamics in severe heart failure patients.
- Both ACE inhibitors appear safe regarding renal function and electrolyte balance in this patient cohort.
Abstract:
24 patients with severe heart failure (NYHA III) were randomly assigned to an additional therapy with captopril or enalapril. The mean daily dose of captopril was 56 +/- 2 mg and of enalapril, 9.6 +/- 0.9 mg. After a mean of 9 days, the influence of both inhibitors of the angiotensin converting enzyme (ACE-inhibitors) on hemodynamics and renal function was evaluated. The mean arterial pressure in the group treated with captopril (group A) fell by 11 +/- 2 mm Hg (p less than 0.001), with enalapril (group B) by 13 +/- 3 mm Hg (p less than 0.01), the difference between the groups not being significant. Heart rate decreased in both groups to a similar degree. The change was significant only in the patients treated with enalapril (13 +/- 4/min; p less than 0.05 vs. 11 +/- 5/min in group A). Stroke volume index increased by 10 +/- 2 ml/m2 in group A vs. 12 +/- 2 ml/m2 in group B; both increases were highly significant (p less than 0.001). Mean decreases in pulmonary artery and right atrial pressure were comparable in both groups. The hemodynamic improvement was not different with both ACE-inhibitors. Serum sodium and potassium before therapy were 137 +/- 1 mmol/l and 4.1 +/- 0.2 mmol/l in group A and 139 +/- 1 mmol/l and 3.8 +/- 0.1 mmol/l in group B and serum creatinine was 1.2 +/- 0.1 mg/dl in both groups. Neither serum electrolytes nor serum creatinin were changed significantly by therapy with captopril or enalapril.(ABSTRACT TRUNCATED AT 250 WORDS)