[Enalapril versus captopril in heart failure--effect on blood pressure and kidney function]

Abstract

In 33 patients with heart failure (NYHA II-III) the 24-h blood pressure was examined during the titration of two ACE-inhibitors. Blood pressure was measured by the oscillometric method using the blood pressure monitor 90202 from SpaceLabs, Inc.. All patients received an additional therapy either with captopril (group A, n = 17) or enalapril (group B, n = 16) in random order. Serum-electrolytes, serum- and urine-creatinine, and plasma-renin- activity were measured before and during therapy with both ACE-inhibitors. 24-h blood pressure measurements were taken before and on the first and fifth days of the treatment with ACE-inhibitors. Neither group was different with respect to the degree of heart failure, the concomitant medication, and the 24-h profiles of blood pressure and heart rate. The mean initial dose of captopril was 9.2 +/- 1.2 mg which was titrated to a mean daily dose of 40.7 +/- 3.3 mg given three-times daily. Each patient of group B received an initial dose of 2.5 mg enalapril and a mean maintenance dose of 8.4 +/- 0.9 mg once daily. The first dose effect on blood pressure was similar with captopril and enalapril with a maximal decrease of systolic and diastolic blood pressure of 8/8 mmHg (after 1 h) in group A and of 9/7 mmHg (after 4 h) in group B. The 24-h blood pressure values on day 5 were consistently below the pretreatment values (p less than 0.005) but heart rate was not significantly affected by either ACE-inhibitor. Neither group differed significantly during ACE-inhibition in their 24-h blood pressure and heart rate profiles.(ABSTRACT TRUNCATED AT 250 WORDS)