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A cooperative multicenter study of captopril in congestive heart failure: hemodynamic effects and long-term response
Insights
Captopril, an oral angiotensin-converting enzyme inhibitor, significantly improved hemodynamics and clinical status in heart failure patients resistant to other treatments. Long-term efficacy and safety were demonstrated without tachyphylaxis.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure management often requires multi-drug approaches.
- Patients resistant to digitalis and diuretics present a therapeutic challenge.
Purpose of the Study:
- To evaluate the acute hemodynamic effects, long-term clinical efficacy, and safety of captopril.
- To assess captopril's impact on patients with refractory heart failure.
Main Methods:
- A multicenter cooperative study involving 124 heart failure patients.
- Hemodynamic parameters and New York Heart Association (NYHA) functional classification were monitored.
- Exercise tolerance testing was performed before and after treatment.
Main Results:
- Captopril demonstrated favorable acute hemodynamic effects, including increased cardiac index and decreased vascular resistance.
- Significant and sustained improvements in NYHA functional class and exercise tolerance were observed in most patients.
- No evidence of tachyphylaxis was noted over an 18-month period.
Conclusions:
- Captopril is effective in improving hemodynamics and clinical status in heart failure patients resistant to digitalis and diuretics.
- The drug offers sustained benefits and a favorable safety profile for long-term management.
- Captopril represents a valuable therapeutic option for refractory heart failure.
Abstract:
The acute hemodynamic effects, long-term clinical efficacy, and safety of the oral angiotensin-converting enzyme inhibitor, captopril, were assessed in a multicenter cooperative study of 124 patients with heart failure resistant to digitalis and diuretics. The cardiac status of most patients was deteriorating prior to the study. Favorable acute hemodynamic effects consistently occurred with captopril. Maximal mean percentage increases in cardiac index, stroke index, and stroke work index were, respectively, 35%, 44%, and 34%. Systemic and pulmonary vascular resistances were each decreased by approximately 40%, as were the filling pressures of the right and left heart. Infusion of nitroprusside in some of the same patients to an end point of a pulmonary capillary wedge pressure of 12 to 18 mm Hg (equivalent to that after captopril) revealed no significant difference in the effect of either drug on the other hemodynamic parameters. Recatheterization after 8 weeks of captopril therapy revealed sustained hemodynamic changes. Significant and sustained improvements in clinical status were observed in most patients as measured by changes in New York Heart Association (NYHA) functional classification and exercise tolerance times. Seventy-nine percent of patients for whom there were adequate NYHA class data improved. Twenty percent remained unchanged and 1% deteriorated. Those patients who had both pretreatment and post-treatment exercise stress testing exhibited a highly significant mean increase in exercise tolerance times of 34% (317 +/- 32 seconds pretreatment to 425 +/- 34 seconds, final measurement). There was no evidence of tachyphylaxis over an 18-month period.(ABSTRACT TRUNCATED AT 250 WORDS)