EFFECTS OF CAPTOPRIL AND ISOSORBIDE DINITRATE ON HEMORHEOLOGICAL PARAMETERS IN PATIENTS WITH CHRONIC CONGESTIVE-HEART-FAILURE DUE TO CORONARY HEART-DISEASE

The aim of the present study was to investigate the hemorheological ef fects of captopril and isosorbide dinitrate (ISDN) in patients with ch ronic congestive heart failure (CHF) due to coronary heart disease (CH D). 51 patients were enrolled in this double-blind, randomised, compar ative trial. All patients had a left ventricular ejection fraction of less than 40% corresponding to NYHA-class II or III, and were on a bas eline regimen with diuretics. During the 3-week run-in phase, treatmen t with captopril was initiated up to a daily dosage of 2x25 mg. Then a ll patients were randomised to receive either ISDN (2x40mg/day) or pla cebo over a 16-weeks double-blind phase. We were able to demonstrate a significant decrease of plasma viscosity (p < 0.05) and white blood c ell count (p < 0.01) during treatment with captopril. The additional t reatment with ISDN did not lead to further changes in the hemorheologi cal profile. In conclusion ACE-inhibition with captopril leads to a mo derate improvement of blood theology in patients with CHF due to CHD. Nitrates added to a baseline treatment with captopril and diuretics do not further improve blood theology. This may be explained by the pron ounced vasodilatory effect of captopril due to inhibition of angiotens in II and increased levels of bradykinin.