EFFECTS OF ANGIOTENSIN-CONVERTING ENZYME- INHIBITORS IN PATIENTS WITHCHRONIC CONGESTIVE CARDIAC-FAILURE

Background: Administration of angiotensin converting enzyme (ACE) inhi bitors to patients with congestive heart failure (CHF) is associated t o a decrease in the abnormal vasoconstrictor neurohormonal activity. T his contributes to the sustained benefits of these drugs on symptoms a nd survival of patients with CHF. There is little information, however , regarding the effects of ACE inhibition on vasodilator and natriuret ic hormones. Aim: To evaluate the chronic effects of enalapril, in add ition to digitalis and diuretics in patients with chronic cardiac fail ure. Patients and methods: Nine patients with an idiopathic dilated ca rdiomyopathy (8 male, aged 48 to 76 years old) under treatment with di gitalis and diuretics, received enalapril 20 mg bid during eight weeks . Before and after this treatment period resting left ventricular ejec tion fraction, functional class, plasma levels of atrial natriuretic f actor and bradykinins (BK) and urinary excretion of kalikreins (BK) an d prostaglandin E-2 (PGE(2)) were measured. Results: After enalapril t herapy, there was a significant increase in maximal O-2 consumption (1 4.8 +/- 1.2 to 18.6 +/- 1.5 ml/kg/min, p<0.05) and radionuclide LV eje ction fraction (27.4 +/- 1.1 to 31.4 +/- 0.9% p<0.05). This was associ ated with a significant decrease in plasma ANP levels (559 +/- 158 to 178 +/- 54.8 pg/ml) and UK (391 +/- 112 to 243 +/- 92 Cu/24 h). Conclu sions: The decrease in ANP levels, which is a well known marker of pro gnosis in CHF, could contribute to explain the sustained clinical bene fits observed with ACE inhibitors in patients with CHF.