Comparison of the immediate and long‐term effects of captopril and isosorbide dinitrate as adjunctive treatment in mild heart failure.

Abstract

1. The efficacy of captopril and isosorbide dinitrate (ISDN) as adjunctive therapy to digoxin and diuretics in mild heart failure was compared in a double‐blind study. 2. Twenty‐one patients were randomly allocated to captopril (twice or three times daily) or ISDN. Eighteen patients completed a protocol of placebo run‐in, dose titration and maintenance treatment for 3 months. 3. Symptom‐limited exercise tolerance, ejection fraction and radionuclide indices of diastolic function estimated by gated blood pool scan did not change with either treatment. 4. Captopril improved functional class (Canadian Cardiovascular Society) and reduced requirements for increased diuretic dosage at both 1 and 3 months of maintenance treatment. Patients treated with ISDN required increased diuretic and did not improve their functional class. Differences between the treatments were significant only for diuretic dosage requirements. 5. We conclude that adjunctive therapy of mild heart failure with captopril administered twice daily provides a diuretic‐sparing effect and may improve functional class during 3 months of maintenance treatment.

Lack of effect of nitrates on exercise tolerance in patients with mild to moderate heart failure caused by coronary disease already treated with captopril.

“…"-" Captopril was given in a low dosage and only twice a day. Wilkes et al 24 showed that twice daily dosage of captopril is effective in patients with mild heart failure. This dose regimen does not provide roundthe-clock inhibition of the plasma reninangiotensin system.…”

Is heart failure with preserved systolic function an overlooked enigma?

“…Nitrate therapy has been examined in a similarly small patient cohort of 21 patients with heart failure and an EF greater than 40% [33]. These patients were randomly assigned to receive isosorbide dinitrate (n = 21) or placebo (n = 18) for 3 months.…”