Effects of perindopril on cardiac sympathetic nerve activity in patients with congestive heart failure: comparison with enalapril

Abstract

Purpose: The production of aldosterone in the heart is suppressed by the angiotensin-converting enzyme (ACE) inhibitor perindopril in patients with congestive heart failure (CHF). Moreover, perindopril has been reported to have more cardioprotective effects than enalapril.

Materials and methods: Forty patients with CHF [left ventricular ejection fraction (LVEF) <45%; mean 33+/-7%] were randomly assigned to perindopril (2 mg/day; n = 20) or enalapril (5 mg/day; n = 20). All patients were also treated with diuretics. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate (WR) were determined from 123I-meta-iodobenzylguanidine (MIBG) images, and plasma brain natriuretic peptide (BNP) concentrations were measured before and 6 months after treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and LVEF were also determined by echocardiography.

Results: After treatment, in patients receiving perindopril, TDS decreased from 39+/-10 to 34+/-9 (P < 0.01), H/M ratios increased from 1.62+/-0.27 to 1.76+/-0.29 (P < 0.01), WR decreased from 50+/-14% to 42+/-14% (P < 0.05) and plasma BNP concentrations decreased from 226+/-155 to 141+/-90 pg/ml (P < 0.0005). In addition, the LVEDV decreased from 180+/-30 to 161+/-30 ml (P < 0.05) and the LVESV decreased from 122+/-35 to 105+/-36 ml (P < 0.05). Although the LVEF tended to increase, the change was not statistically significant (from 33+/-8% to 36+/-12%; P = NS). On the other hand, there were no significant changes in these parameters in patients receiving enalapril.

Conclusion: Plasma BNP concentrations, 123I-MIBG scintigraphic and echocardiographic parameters improved after 6 months of perindopril treatment. These findings indicate that perindopril treatment can ameliorate the cardiac sympathetic nerve activity and the left ventricular performance in patients with CHF.