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Combined therapy of captopril and spironolactone for refractory congestive heart failure
Insights
Combining captopril with spironolactone effectively treats severe congestive heart failure (CHF) patients, improving symptoms and reducing aldosterone levels without causing hyperkalemia.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe congestive heart failure (CHF) patients often have persistent edema and congestion despite angiotensin-converting enzyme inhibitor (ACEI) therapy.
- Simultaneous use of ACEIs and spironolactone was previously contraindicated due to hyperkalemia risk.
- Elevated plasma aldosterone levels are common in refractory CHF.
Purpose of the Study:
- To evaluate the efficacy and safety of combining captopril with spironolactone in patients with refractory CHF.
- To assess the impact on clinical symptoms, renal function, electrolytes, and aldosterone levels.
Main Methods:
- A randomized trial involving 35 patients with refractory CHF (NYHA class IV) without renal dysfunction, hypotension, or hyperkalemia.
- Patients received either captopril alone (Group A, n=16) or captopril plus spironolactone (Group B, n=19) for 4 weeks.
- Strict monitoring of renal function, electrolytes, blood pressure, and plasma aldosterone levels was conducted, with individualized drug dosage adjustments.
Main Results:
- Group B showed significantly greater improvement in dyspnea-fatigue, urinary volume, and urinary Na+/K+ ratio compared to Group A.
- Plasma aldosterone levels decreased significantly in Group B, while remaining high in Group A.
- No patients experienced significant hyperkalemia or hypoaldosteronism.
Conclusions:
- Captopril combined with spironolactone is an effective and safe treatment for refractory CHF patients with elevated aldosterone levels.
- This combination therapy improves clinical status and reduces aldosterone levels without inducing hyperkalemia.
- Urinary Na+/K+ ratio may serve as a marker for treatment response in these patients.
Abstract:
It is traditionally considered that angiotensin--converting enzyme inhibitor (ACEI) and spironolactone could not be used simultaneously because of the assumed risk of hyperkalemia. However, despite ACEI therapy edema and congestive status remain in some of the patients with severe congestive heart failure (CHF). In order to seek an effective therapy for these patients, we observed the efficacy and safety of captopil plus spironolactone in patients with refractory CHF, with strict monitoring of renal function, serum and urine electrolytes and blood pressure (BP). Thirty-five patients with refractory CHF and New York Heart Association functional class IV without renal dysfunction, hypotension and hyperkalemia, whose plasma aldosterone (ALD) level in 88.6% of them was above normal value, were randomly assigned to group A (n = 16, captopril alone) and B (n = 19, captopril plus spironolactone) for a 4-week treatment. The dosage of both drugs was individually adjusted in time according to the results of serum potassium and renal function. The improvement in dyspnea--fatigue ratings, urinary volume and Na+/K+ ratio in group B was more significant than that in group A, and the plasma ALD level in group B decreased obviously while it remained high in group A after therapy. Two patients in group B who had had normal plasma ALD level with urinary Na+/K+ ratio > 1.0 before the therapy did not exhibit any clinical improvement. A strong negative correlation was found between plasma ALD level and urinary Na+/K+ ratio (correlation coefficient -0.689, P < 0.01). None of the patients had obvious hyperkalemia and hypoaldosteronism.(ABSTRACT TRUNCATED AT 250 WORDS)