Clinical and neurohumoral response of patients with severe congestive heart failure treated with two different captopril dosages

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Abstract
Although angiotensin converting enzyme inhibitor therapy is an established approach in the treatment of chronic heart failure, the required dosage remains unclear. This open 6 month study investigated the influence of different captopril dosages on the clinical course and neurohumoral activity of patients with severe heart failure (left ventricular ejection fraction ≤ 20%). Eighty-five patients in New York Heart Association class II-IV despite treatment with digitalis, diuretics, and captopril (mean dose ± SEM 28±2 mg. day−1 at baseline) for ≥ 3 months received either ‘low dose’ captopril (−1, mean 32±2 mg. day−1; n = 46) or ‘high dose’ captopril(≥ 75mg. day−1,mean99±4 mg. day−1; n = 39) during the follow-up period. Both groups were comparable in clinical, haemodynamic and neurohumoral parameters at baseline. Functional state improved significantly only in the high dose group (P P P P <0.01). Renin increased significantly in both groups. These observations underline the necessity of suppressing neurohumoral overactivation with adequate doses of captopril reflected by sequential humoral plasma determination.

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