Dose-related effects of ACE inhibition in man: quinapril in patients with moderate congestive heart failure. The Study Group on Neurohormonal Regulation in Congestive Heart Failure: Lausanne, Switzerland; Berlin, Düsseldorf, Munich, Germany

Autor: Nussberger, J., Fleck, E., Bahrmann, H., Delius, W., Schultheiss, H. P., Brunner, H. R.
Rok vydání: 1994
Předmět:
Adult
Heart Failure
Male
Neurotransmitter Agents
Dose-Response Relationship
Drug
Hemodynamics
Quinapril
Administration
Oral
Angiotensin-Converting Enzyme Inhibitors
Middle Aged
Isoquinolines
Drug Administration Schedule
Ventricular Function
Left
Renin-Angiotensin System
Double-Blind Method
Administration
Oral Adult Aged Angiotensin-Converting Enzyme Inhibitors/*administration & dosage/adverse effects Dose-Response Relationship
Drug Double-Blind Method Drug Administration Schedule Exercise Test/drug effects Female Heart Failure
Congestive/*drug therapy/physiopathology Hemodynamic Processes/*drug effects/physiology Humans Isoquinolines/*administration & dosage/adverse effects Male Middle Aged Neurotransmitter Agents/blood Renin-Angiotensin System/drug effects/physiology *Tetrahydroisoquinolines Ventricular Function
Left/drug effects/physiology
Tetrahydroisoquinolines
Exercise Test
Humans
Female
Aged
Zdroj: European Heart Journal, vol. 15 Suppl D, pp. 113-22
ISSN: 0195-668X
Popis: Early treatment with ACE inhibitors of even moderate heart failure is clinically beneficial, even though haemodynamic measurements cannot adequately quantitate such improvement. Neurohumoral assessment is, however, supposed to be more accurate. In 55 patients with moderate heart failure (ejection fraction < or = 35%), we investigated the dose-dependent effects of ACE inhibition with quinapril taken orally (2.5, 5 or 10 mg b.i.d.) following a placebo-controlled, parallel design protocol over 12 weeks. Plasma components of the renin angiotensin system, catecholamines and ANF were measured together with haemodynamics both at rest and during exercise. Before ACE inhibitor treatment, median PRA, Ang I and II and catecholamines were normal, while ANF was increased. All these parameters, including ACE activity, rose during exercise. Chronic inhibition of ACE activity was dose-dependent and the maximal fall in Ang II occurred with quinapril 20 mg.day-1. Humoral changes appeared more assessible than haemodynamic alterations even though many of these changes were reasonably correlated. The effects of chronic ACE inhibition on circulating neurohumoral components in patients with moderate heart failure are small and dose-dependent. Since humoral changes are related to haemodynamics they should account for the clinical benefit. Appropriately high doses of ACE inhibitors should be chosen for treatment of heart failure.
Databáze: OpenAIRE
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