Sustained Effectiveness of Converting-Enzyme Inhibition in Patients with Severe Congestive Heart Failure

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Abstract
Eight patients with severe congestive heart failure refractory to conventional therapy, including vasodilators, were given captopril (seven patients) or teprotide (one patient). All had dyspnea, edema, elevated pulmonary wedge pressure (28.0±2.6 mm Hg), low cardiac index (1.6±0.1 liters per minute per square meter), and elevated levels of serum creatinine (2.3±0.2 mg per deciliter [203.3±17.7 μmol per liter]), blood urea nitrogen (48±5 mg per deciliter [17.1±1.8 mmol of urea per liter]), plasma renin activity (21±7 ng of angiotensin I per milliliter per hour), plasma angiotensin II (271±51 pg per milliliter), and plasma aldosterone (65±14 ng per deciliter). After one week of therapy, all indexes improved. Creatinine and p-aminohippurate clearances were also increased (P<0.01). Improvement was sustained (more than six months) and was associated with a statistically significant increase in the cardiac ejection fraction (12±3 to 26±7 per cent).