Blood pressure response to the first 36 hours of heart failure therapy with perindopril versus captopril

An open randomized hospital study conducted in 169 centers in France compar ed the blood pressure response to the first 36 h of treatment with perindop ril (PER), 2 mg once daily, with that to captopril (CAP), 6.25 mg t.i.d., i n 725 patients (mean age, 70 years; men, 67%) with echocardiographic left v entricular systolic dysfunction (fractional shortening, less than or equal to 28%) due to ischemia (56.7%) or hypertension (34.5%) and a systolic bloo d pressure (SBP) greater than or equal to 120 mm Hg. Each dose of CAP induc ed a sharp and rapid decrease in blood pressure (maximum, 1.5-2 h); with PE R, the decrease was gradual (maximum, 6 h) and variation was less marked. H owever, at 36 h, the decrease in blood pressure versus baseline was similar on both treatments. Over the 36-h period, there were 22 (3%) dropouts due to marked orthostatic hypotension (SBP, <90 mm Hg), and they were fewer wit h PER than with CAP: 16 cases in the CAP group versus six in the PER group (p = 0.036). At 36 h, heart rate was lower with CAP than with PER: 75.2 ver sus 77.5 beats/min, respectively (p = 0.039). As initial therapy for stabil ized left ventricular systolic dysfunction, the first dose of PER (2 mg) in duced a significantly smaller decrease in blood pressure than the first dos e of CAP (6.25 mg); dropouts due to orthostatic hypotension were also signi ficantly fewer with PER than with CAP.