Related Experiment Videos
Effect of long-term enalapril therapy on neurohormones in patients with left ventricular dysfunction. SOLVD
C R Benedict1, G S Francis, B Shelton
1Division of Cardiology, University of Texas Medical School, Houston, 77030, USA.
Insights
Enalapril treatment in patients with heart failure and left ventricular dysfunction showed a trend toward reducing plasma norepinephrine levels compared to placebo. This suggests potential benefits in managing neurohormonal imbalances in heart failure patients.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Elevated neurohormonal levels correlate with increased mortality in congestive heart failure.
- Angiotensin-converting enzyme inhibitors, like enalapril, are known to reduce mortality and morbidity in heart failure patients.
- The Studies of Left Ventricular Dysfunction (SOLVD) trials investigated enalapril's effects in symptomatic and asymptomatic patients.
Purpose of the Study:
- To compare long-term effects of enalapril versus placebo on plasma neurohormones in patients with left ventricular dysfunction.
- To assess enalapril's impact on norepinephrine, renin activity, atrial natriuretic peptide, and arginine vasopressin.
- To analyze neurohormonal changes in both symptomatic (treatment trial) and asymptomatic (prevention trial) patient groups.
Main Methods:
- Analysis of plasma neurohormone levels (norepinephrine, renin activity, ANP, vasopressin) at baseline and follow-up (4 and 12 months).
- Utilized analysis of covariance models to determine enalapril's effect on neurohormones.
- Compared neurohormonal levels between treatment trial, prevention trial, and normal control subjects.
Main Results:
- Patients in the treatment trial exhibited significantly higher baseline neurohormonal levels than prevention trial patients or controls.
- In the treatment trial, enalapril therapy led to a greater decrease in plasma norepinephrine levels compared to placebo (p < 0.08).
Conclusions:
- Enalapril demonstrated a trend towards reducing plasma norepinephrine in patients with symptomatic left ventricular dysfunction.
- Neurohormonal profiles differed significantly between symptomatic and asymptomatic heart failure patients.
- Further investigation into enalapril's long-term neurohormonal effects in heart failure is warranted.
Abstract:
The aim of this study was to compare the long-term effects of treatment with enalapril or placebo on plasma neurohormones in patients with left ventricular (LV) dysfunction. Elevated neurohormonal levels are associated with increased mortality in patients with congestive heart failure. Multiple studies have shown that angiotensin-converting enzyme inhibitors decrease mortality and morbidity in these patients. In Studies of Left Ventricular Dysfunction (SOLVD), enalapril significantly reduced mortality in patients with symptomatic LV dysfunction (treatment trial). In contrast, in patients with asymptomatic LV dysfunction (prevention trial), there was no significant reduction in mortality with enalapril therapy. The effect of enalapril was examined in 333 prevention trial and 129 treatment trial patients. Plasma norepinephrine (NE) and plasma renin activity were measured in these patients at baseline, and at 4 and 12 months of follow-up. In a subset of these patients, atrial natriuretic peptide (ANP) and arginine vasopressin were also measured. Analysis of covariance models were used to determine the effect of enalapril on each neurohormone. Participants in the treatment trial had significantly higher neurohormonal levels when compared with those in the prevention trial or normal control subjects. In the treatment trial, patients taking enalapril had a greater decrease in plasma NE levels than patients taking placebo (p < 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)