Abstract
Background: At present there is little dispute that clinical tolerance of organic nitrates occurs during long‐term treatment of patients with stable angina pectoris and congestive heart failure.
Hypothesis: Captopril exerts a favorable hemodynamic effect in coronary patients with heart failure who are clinically tolerant to nitroglycerin.
Methods: Development of nitrate tolerance was observed during intravenous nitroglycerin treatment (10 mg/h) in 16 of 19 patients (7 women, 12 men; mean age 56 ± 8 years) with coronary heart disease [stenosis ≥ 75%, New York Heart Association (NYHA) classes II–III). The criterion applied was a loss of efficacy of at least 50% with regard to mean pulmonary capillary wedge pressure compared with the maximum effect of nitrate. The effect of captopril (50 mg p.o.) was determined in a blank test. Captopril (50 mg p.o.) was administered again at the stage of clinically manifest nitrate tolerance.
Results: Compared with the effect of captopril alone, significantly more pronounced reductions in mean pulmonary capillary wedge pressure (33% compared with 27%) and in mean pulmonary arterial pressure (36% compared with 17%) and significantly greater increases in cardiac index (14% compared with 7%) and stroke work index (34% compared with 18%) (p < 0.05 in each case; Wilcoxon test for linked random samples) were measured. Maintaining nitroglycerin infusion, the effect of captopril (at least 90% of the maximum effect) lasted for 123 ± 24 min. The baseline values (at least 75% decline in the effect of captopril) were only reached after 369 ± 34 min.
Conclusion: The results document a favorable hemodynamic effect of captopril in nitrate tolerance which is significantly better than that of captopril alone.
Keywords: captopril, nitrate tolerance, nitroglycerin, coronary heart disease, heart failure
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