Effects of the angiotensin‐converting enzyme inhibitor alacepril on exercise capacity and neurohormonal factors in patients with mild‐to‐moderate heart failure

Abstract

1. Alacepril is a long-acting, sulphydryl-containing angiotensin-converting enzyme inhibitor. Data are limited regarding the effects of alacepril on exercise tolerance in patients with chronic heart failure (CHF). The aim of the present study was to determine the effects of chronic alacepril treatment on exercise capacity and neurohormones in patients with CHF. 2. The effects of 12 weeks treatment with alacepril on clinical, echocardiographic and cardiopulmonary exercise variables were studied in 18 CHF patients (mean age: 63 +/- 2 years; New York Heart Association (NYHA) class I n = 6, class II n = 10, class III n = 2) in a cross-over fashion. Resting levels of plasma noradrenaline, renin-angiotensin system activity and natriuretic peptides were evaluated. 3. Treatment with alacepril significantly improved NYHA functional class and decreased cardiothoracic ratio (60.1 +/- 2.0 vs 58.1 +/- 1.9% for baseline vs alacepril, respectively; P < 0.01). Cardiac dimensions by echocardiogram were decreased after alacepril therapy. Peak Vo2 (17.7 +/- 1.2 vs 19.5 +/- 1.3 mL/min per kg; P < 0.01) and anaerobic threshold (11.7 +/- 0.6 vs 13.2 +/- 0.9 mL/min per kg; P < 0.01) increased with alacepril treatment. Plasma noradrenaline and plasma angiotensin II levels were not altered, but plasma aldosterone (77.7 +/- 13.5 vs 51.7 +/- 9.7 pg/mL; P < 0.01), atrial natriuretic peptide (ANP; 86.5 +/- 20.3 vs 43.6 +/- 7.6 pg/mL; P < 0.05) and brain natriuretic peptide (BNP; 222.7 +/- 59.3 vs 117.7 +/- 34.3 pg/mL; P < 0.05) levels decreased after alacepril treatment. 4. These results suggest that treatment with alacepril improves functional status and exercise capacity in patients with mild-to-moderate CHF. Neurohormones were favourably influenced by alacepril therapy, with significant decreases in plasma aldosterone, ANP and BNP levels.

Serial analyses of N-terminal pro-B-type natriuretic peptide in patients with non–ST-segment elevation acute coronary syndromes

“…However, other studies have shown that long-term treatment with angiotensin-converting enzyme inhibitors (26), beta-blockers (27), and diuretics (28) decrease BNP levels. We cannot, therefore, exclude that initiation of such treatments might have contributed to the decreasing NT-proBNP levels, especially during the later part of the measurement period.…”

The Relationship between Reactive Oxygen Species and Cardiac Fibrosis in the Dahl Salt-Sensitive Rat under ACEI Administration

“…Currently, five such ACEIs are commercially available for veterinary use; however, these drugs have not been fully investigated through comparative studies to determine which of these drugs is more effective and advantageous in treating heart failure. For example, although alacepril is a long-acting, sulfhydryl-containing ACEI, very little information is available regarding its cardioprotective effects [9]. In the present study, we evaluated the cardioprotective effects of alacepril and compared the effects with another ACEI, enalapril, which is widely used in veterinary medicine.…”

B-type natriuretic peptides as powerful markers in cardiac diseases: Analytical and clinical aspects

“…Criteria such as cardiothoracic ratio and left ventricular end-diastolic diameters (124) or increases in maximal exercise capacity during the bicycle exercise stress test and improvement in NYHA class were associated with decreases in BNP concentrations during follow-up of congestive HF patients (125). However, most studies report mean natriuretic peptide changes in parallel with different criteria for the improvement of HF without showing the individual course of a patient.…”