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Indications and effects of captopril therapy in childhood
1Hungarian Institute of Cardiology, Budapest.
Insights
Captopril effectively managed chronic congestive heart failure (CHF) and hypertension in pediatric patients. The drug showed significant clinical improvement in CHF and reduced blood pressure in hypertensive individuals, with good tolerability.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Internal Medicine
Background:
- Congestive heart failure (CHF) and hypertension are serious conditions in children.
- Digitalis and diuretic-resistant cases present significant treatment challenges.
- Captopril is an angiotensin-converting enzyme (ACE) inhibitor.
Purpose of the Study:
- To evaluate the chronic effects of captopril in pediatric patients with resistant CHF or hypertension.
- To assess captopril's efficacy and tolerability in this population.
Main Methods:
- A study involving 29 pediatric patients (4 months to 16 years) with CHF or hypertension.
- Patients received captopril for 1 to 31 months at varying dosages.
- Echocardiographic and clinical assessments were performed.
Main Results:
- In CHF patients, 59% showed clinical improvement; survivors had improved cardiothoracic index and ejection fraction.
- Hypertensive patients experienced a significant decrease in blood pressure.
- Captopril was generally well-tolerated, with one case of reversible anemia.
Conclusions:
- Captopril demonstrates significant benefit in managing chronic congestive heart failure in pediatric patients.
- Captopril is effective in controlling severe hypertension in children, alone or with other medications.
Abstract:
Chronic effects of captopril were studied in 29 patients (age, 4 months to 16 years; mean, 6.9 years) suffering from digitalis and diuretic resistant congestive heart failure (CHF) or hypertension of different etiology. Twenty two patients with CHF (13 dilated, 4 restrictive cardiomyopathy, 5 congenital heart defects) and 7 cases with hypertension were treated for 1 to 31 months (mean, 9 months). The dose of captopril varied from 1 to 3 mg/kg/day (mean, 2.2 mg) in CHF and from 1.1 to 6.8 mg/kg/day (mean, 3.7 mg) in hypertension. In CHF digoxin therapy was maintained while the dose of diuretics could be reduced or discontinued. In 4 severely hypertensive patients the addition of a diuretic or beta blockers was necessary. In CHF clinical improvement was observed in 13 patients (59%), while there was no response in 4 and 5 patients died. The survivors exhibited a significant decrease of the cardiothoracic index (p less than 0.05), the PEP/LVET ratio (p less than 0.05) and an increase of the echocardiographic linear ejection fraction (p less than 0.001). If hypertension was present, blood pressure decreased in all patients (p less than 0.05). Captopril was well tolerated by all patients except one who developed anaemia. This side effect disappeared after having discontinued the drug. These findings suggest that captopril is of benefit in controlling chronic CHF. Captopril alone or in combination with other drugs is effective in the management of severe hypertension.