Titre du document / Document title

Low-dose but not high-dose captopril increases parasympathetic activity in patients with heart failure

Auteur(s) / Author(s)

KAMEN P. W. ⁽¹⁾ ; KRUM H. ⁽²⁾ ; TONKIN A. M. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Cardiology, Austin & Repatriation Medical Centre, Melbourne, AUSTRALIE
⁽²⁾ Department of Clinical Pharmacology, Austin & Repatriation Medical Centre, Melbourne, AUSTRALIE

Résumé / Abstract

Parasympathetic nervous activity (PSNA) is an important determinant of the risk of sudden death and outcome in patients with cardiovascular disease, so the effects of drug therapy on PSNA may be of prognostic importance in patients with chronic heart failure (CHF). The angiotensin-converting enzyme (ACE) inhibitors are the only drugs that are reasonably accepted to improve prognosis in such patients. Accordingly we determined PSNA by heart-rate variability (HRV) analysis in nine patients (four women and five men, aged 73.6 ± 6 yrs) with heart failure (NYHA Classes II-III) and in sinus rhythm. HRV was determined during 20-40 min supine rest at baseline and then at 2-weekly intervals during incremental dosing of oral captopril, 12.5 mg b.i.d., 25 mg b.i.d., and 50 mg b.i.d. Poincaré plot and conventional time- and frequency-domain measures were used to analyze the data. Low-dose captopril (12.5 mg b.i.d.) resulted in an increase in SD delta RR (16.0 ± 6.6 to 22.0 ± 9.1 ms; p < 0.05). We previously validated this as a measure of PSNA. Higher dose captopril (25 mg b.i.d.) also produced an increase in PSNA activity (16.0 ± 6.6 to 18.7 ± 7.8 ms), although this failed to reach statistical significance. However, the highest dose of captopril (50 mg b.i.d.) reduced PSNA activity to near-baseline values, as shown by measures of HRV in both the time and frequency domains. These data suggest that only a low dose of captopril augments PSNA in patients with heart failure. Dosing of ACE inhibitors may be important in optimizing their benefit in CHF.

Revue / Journal Title

Journal of cardiovascular pharmacology   ISSN 0160-2446   CODEN JCPCDT 

Source / Source

1997, vol. 30, n^o1, pp. 7-11 (35 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott, Hagerstown, MD, ETATS-UNIS  (1979) (Revue)

Mots-clés anglais / English Keywords

Captopril ; Antihypertensive agent ; ACE inhibitor ; Chemotherapy ; Treatment ; Heart failure ; Human ; Coronary sinus rhythm ; Dose activity relation ; Low dose ; High dose ; Parasympathetic nervous system ; Heart rate ; Effective dose ; Dosage adjustment ; Cardiovascular disease ; Heart disease ; Arrhythmia ; Excitability disorder ;

Mots-clés français / French Keywords

Captopril ; Antihypertenseur ; Inhibiteur angiotensin converting enzyme ; Chimiothérapie ; Traitement ; Insuffisance cardiaque ; Homme ; Rythme sinus coronaire ; Relation dose réponse ; Dose faible ; Dose forte ; Système nerveux parasympathique ; Rythme cardiaque ; Dose efficace ; Ajustement posologie ; Appareil circulatoire pathologie ; Cardiopathie ; Trouble rythme cardiaque ; Trouble excitabilité ;

Mots-clés espagnols / Spanish Keywords

Captopril ; Antihipertensivo ; Inhibidor angiotensin converting enzyme ; Quimioterapia ; Tratamiento ; Insuficiencia cardíaca ; Hombre ; Ritmo sinusal coronario ; Relación dosis respuesta ; Dosis débil ; Dosis fuerte ; Sistema nervioso parasimpático ; Ritmo cardíaco ; Dosis eficaz ; Aparato circulatorio patología ; Cardiopatía ; Arritmia ; Trastorno excitabilidad ;

Localisation / Location

INIST-CNRS, Cote INIST : 18065, 35400006816095.0020