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Enalapril in congestive heart failure: acute and chronic invasive hemodynamic evaluation
Insights
Enalapril effectively improved heart function and exercise capacity in patients. This medication, enalapril, demonstrated significant hemodynamic benefits and enhanced clinical status during chronic therapy.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure management often requires optimizing hemodynamic parameters.
- Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used for cardiovascular conditions.
Purpose of the Study:
- To evaluate the hemodynamic and clinical efficacy of enalapril in patients.
- To determine the optimal single oral dose of enalapril based on hemodynamic response.
Main Methods:
- An open, uncontrolled, multicenter study involving 73 patients.
- Dose-finding of oral enalapril (1.25-40 mg) based on invasive and noninvasive hemodynamic evaluation.
- Hemodynamic measurements taken at multiple time points post-dose and during chronic therapy (1-4 months).
Main Results:
- Optimal enalapril dose significantly increased cardiac index (42%) and decreased pulmonary capillary wedge pressure (40%), systemic vascular resistance (39%), and mean arterial pressure (23%).
- These hemodynamic improvements were sustained with chronic enalapril treatment.
- Chronic therapy also improved exercise capacity (40%), ejection fraction (18%), and New York Heart Association (NYHA) functional class.
Conclusions:
- Single oral doses of enalapril achieve significant and sustained hemodynamic improvements in patients.
- Enalapril is effective in improving exercise capacity, ejection fraction, and clinical status in the long term.
- Doses of 10-20 mg/day, administered once or twice daily, were most commonly effective.
Abstract:
Following hemodynamic evaluation using invasive and noninvasive methods, 73 patients were treated in an open, uncontrolled, multicenter study with single oral doses of enalapril maleate 1.25 to 40 mg until the optimal dose for each patient (based upon hemodynamic response) was achieved. Diuretics were withheld and reinstituted only if necessary. Hemodynamic measurements were made at 0 (predrug), 1, 2, 3, 4, 6, 8, 10, 12 and 24 hours postdrug. Patients were discharged on their optimal dose, treated 1 to 4 months and then rehospitalized for repeat hemodynamic measurements. The optimal enalapril single dose was associated with the following mean peak responses: increased cardiac index 42% (SE = 6) and decreased pulmonary capillary wedge pressure 40% (SE = 3), systemic vascular resistance 39% (SE = 2), and mean arterial pressure 23% (SE = 1.5). These changes persisted during chronic therapy. Chronic treatment with enalapril also improved exercise capacity 40% (P less than 0.01), ejection fraction 18% (P less than 0.05) and clinical status (N.Y.H.A. functional class, P less than 0.01). Ten and 20 mg/day, taken as once- or twice-daily regimens, were the most commonly effective doses.