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Effects of lisinopril on congestive heart failure in normotensive patients with diastolic dysfunction but intact
C C Lang1, H M McAlpine, N Kennedy
1Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee, UK.
Insights
Lisinopril did not improve diastolic function in patients with heart failure and preserved ejection fraction. This angiotensin converting enzyme inhibitor reduced blood pressure but did not enhance cardiac filling or symptoms in this patient group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Diastolic dysfunction is a key component of heart failure with preserved ejection fraction (HFpEF).
- Ischaemic heart disease frequently contributes to diastolic dysfunction.
Purpose of the Study:
- To investigate the efficacy of lisinopril in improving diastolic function in patients with HFpEF secondary to ischaemic heart disease.
Main Methods:
- A placebo-controlled, double-blind, crossover study involving 12 normotensive patients (mean age 72 years).
- Treatments included 5 weeks of oral lisinopril or placebo.
- Diastolic function assessed using radionuclide ventriculography and Doppler echocardiography.
- Plasma renin activity and norepinephrine levels were measured.
Main Results:
- Lisinopril significantly reduced blood pressure and increased plasma renin activity.
- No significant improvements were observed in radionuclide-derived filling rates or Doppler echocardiographic E:A ratios.
- Patient-reported symptoms did not improve with lisinopril treatment.
Conclusions:
- Lisinopril does not appear to improve diastolic function or symptoms in patients with HFpEF due to ischaemic heart disease.
- The role of angiotensin converting enzyme inhibitors in isolated diastolic dysfunction remains uncertain.
Abstract:
This study examined the effects of lisinopril on diastolic function in 12 normotensive patients (mean age 72 years) with symptomatic congestive heart failure, intact left ventricular systolic function and abnormal diastolic function secondary to ischaemic heart disease in a placebo-controlled double blind crossover study, with each treatment dosed orally for 5 continuous weeks. Compared to placebo, lisinopril significantly decreased blood pressure, increased plasma renin activity without altering heart rate or plasma norepinephrine. There was no statistically significant improvement with lisinopril in radionuclide derived peak filling rate and time to peak filling rate, in Doppler echocardiographic measurements of the ratio of peak flow velocity in early diastole to the peak flow velocity of atrial contraction (E:A ratio) and in visual analogue scales of symptoms. Thus, although angiotension converting enzyme inhibitors may have an established role in the treatment of heart failure secondary to left ventricular systolic dysfunction, its use in patients with isolated diastolic dysfunction remains unclear.