Treatment of mild and moderate heart failure with captopril: a multicenter trial

Purpose - Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class Il and III (NYHA) congestive heart failure ( CHF ). Methods - One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 ± 11); 67 were male and 66 were aucasians. The etiologies ofthe heart failure were. hypertensive heart disease 47 (40.9%), schemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idyopathic cardiomyapathy 15 ( 13,0%), and other causes 6 (5,2%). Diuretic and digitalis were mantained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. Results - The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 ± 13.1 mg day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01 ) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 ( 85.2%) patients and remained unchanged in 17 (14.8%) (p < 001) The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment Conclusion - The addition of captopril to the conventional therapy of class II and III CHF was associated with signifcant improvement of functional class and with good tolerability