Low-dose captopril in chronic heart failure: acute haemodynamic effects and long-term treatment
Sharpe, D.N.; Douglas, J.E.; Coxon, R.J.; Long, B.
Lancet 2(8205): 1154-1157
1980
ISSN/ISBN: 0140-6736 PMID: 6107767 Document Number: 167958
The acute hemodynamic effects of low doses of the oral converting-enzyme inhibitor, captopril, were studied in 18 patients with severe chronic heart failure. The effects of long-term therapy were evaluated. Increasing doses (1, 2.5, 6.25, 12.5 and 25 mg) of captopril were given at 2 h intervals with hemodynamic monitoring. Graded hemodynamic improvement (increased stroke-volume index and reduced mean pulmonary capillary wedge pressure) was noted from 1 h and was closely associated with reduction of blood pressure. Maximal hemodynamic improvement for the group was seen at 6 and 7 h after the 6.25 and 12.5 mg doses, when stroke-volume index had risen 35% and mean pulmonary capillary wedge pressure had fallen 40% from control. Captopril, 12.5-50 mg every 8 h, was continued long term but was withdrawn in 2 patients with symptomatic hypotension and 1 patient with altered taste. Four patients died and 1 was noncompliant with therapy. At 3 mo., 10 patients showed significant improvement in symptoms, treadmill-exercise duration and ECG indices of left-ventricular size and function. Repeat hemodynamic measurements were similar to optimum measurements obtained during the initial study.