Haemodynamic, hormonal, and electrolyte responses to withdrawal of long-term captopril treatment for heart failure
Maslowski, A.H.; Nicholls, M.G.; Ikram, H.; Espiner, E.A.; Turner, J.G.
Lancet 2(8253): 959-961
1981
ISSN/ISBN: 0140-6736 PMID: 6117729 Document Number: 176567
To determine whether temporary cessation of captopril therapy compromises cardiac performance, hemodynamic, hormonal, and electrolyte indices were measured for 2 days before, and 4 days after discontinuation of long-term captopril treatment in 5 patients with heart failure. Captopril withdrawal resulted in a 4-fold rise in plasma angiotensin II, higher levels of noradrenaline , and a 13.5 mmHg increase in mean arterial pressure. Despite these changes, cardiac output at rest and during exercise was well maintained, and right-heart pressures were unaltered. Although plasma aldosterone levels increased 3-fold, neither Na retention nor K depletion occurred. Cortisol levels rose in parallel with angiotensin II levels. In the short term, cardiac performance is not impaired and electrolyte balance is not adversely affected by the abrupt withdrawal of captopril.