PMID- 8422001
OWN - NLM
STAT- MEDLINE
DCOM- 19930218
LR  - 20190622
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 71
IP  - 3
DP  - 1993 Jan 21
TI  - Captopril and spironolactone therapy for refractory congestive heart failure.
PG  - 29A-33A
AB  - Short- and long-term clinical effects of the angiotensin-converting enzyme (ACE) 
      inhibitor captopril in severe congestive heart failure (CHF) were evaluated 
      during a 3-year open study of 124 inpatients with New York Heart Association 
      (NYHA) functional class III or IV CHF refractory to treatment with cardiac 
      glycosides and high doses of loop diuretics. Captopril was added to each 
      patient's regimen, which comprised combinations of furosemide (124 patients), 
      digitalis (117 patients), and spironolactone (90 patients). By the end of the 
      first month of captopril administration, improvement in NYHA functional class was 
      seen in 89 patients (72%). During the first year of captopril treatment, the 
      number of hospital admissions and hospital days declined significantly (p < 
      0.001) and functional class improved significantly (p < 0.001). Although most 
      patients tolerated captopril well, 44% experienced hypotension, which in 10% of 
      patients necessitated termination of captopril therapy. Although mean serum 
      potassium levels tended to increase, serious hyperkalemia did not occur. After 1 
      year, a subset of 30 patients who had not initially received spironolactone 
      deteriorated clinically and manifested increasing urinary aldosterone levels. 
      Hypotension precluded increasing the captopril dose, but introduction of 
      spironolactone improved clinical status in this cohort. The results suggest that 
      rational therapy for severe CHF includes addition of the aldosterone antagonist 
      spironolactone to low doses of captopril (or another ACE inhibitor) and high 
      doses of loop diuretics, provided renal function is adequate.
FAU - Dahlstrom, U
AU  - Dahlstrom U
AD  - Department of Cardiology, Linkoping University Hospital, Sweden.
FAU - Karlsson, E
AU  - Karlsson E
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 27O7W4T232 (Spironolactone)
RN  - 4964P6T9RB (Aldosterone)
RN  - 9G64RSX1XD (Captopril)
RN  - 9NEZ333N27 (Sodium)
RN  - RWP5GA015D (Potassium)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aldosterone/urine
MH  - Captopril/administration & dosage/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heart Failure/*drug therapy/metabolism
MH  - Humans
MH  - Kidney/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Potassium/blood
MH  - Sodium/blood
MH  - Spironolactone/administration & dosage/*therapeutic use
EDAT- 1993/01/21 00:00
MHDA- 1993/01/21 00:01
CRDT- 1993/01/21 00:00
PHST- 1993/01/21 00:00 [pubmed]
PHST- 1993/01/21 00:01 [medline]
PHST- 1993/01/21 00:00 [entrez]
AID - 0002-9149(93)90242-5 [pii]
AID - 10.1016/0002-9149(93)90242-5 [doi]
PST - ppublish
SO  - Am J Cardiol. 1993 Jan 21;71(3):29A-33A. doi: 10.1016/0002-9149(93)90242-5.