RESUMO
Afterload reduction with angiotensin-converting enzyme inhibitors (ACE-inhibitors), such as captopril, is an established therapeutic measure in the adjunctive treatment of severe chronic heart failure. Unfortunately, several side effects and adverse reactions are related to this form of therapy. Calcium antagonists of the dihydropyridine group can also induce a similar afterload reduction, and substances of this group exhibit only a few adverse reactions. In the present double-blind study, the acute and chronic hemodynamic and clinical benefits of the calcium antagonist nisoldipine (= BAY K 5552) were compared with captopril in the adjunctive treatment of patients with heart failure (NYHA III or IV). The study group consisted of 17 patients. After randomization, 9 were treated with captopril (25 mg orally t.i.d.) and 8 with nisoldipine (3 were given 20 mg orally t.i.d., and 5 were given 20 mg b.i.d.). The following hemodynamic variables were obtained in the control phase after 3 days and 3 months' duration of treatment: heart rate, LVEF, SVI, ESVI, EDVI, PSP/ESVI (ratio of peak systolic pressure and end-systolic volume index), CI and systemic vascular resistance. The clinical status of the patients was assessed by means of seven criteria on an arbitrary scale. The following results were obtained: for the nisoldipine group, the average LVEF increased significantly from 0.26 to 0.31 within 3 days of treatment, but after 3 months, this increase had disappeared. All other hemodynamic parameters did not change significantly within either 3 days or 3 months of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)