PMID- 9422837
OWN - NLM
STAT- MEDLINE
DCOM- 19980203
LR  - 20200225
IS  - 0160-9289 (Print)
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Linking)
VI  - 20
IP  - 12
DP  - 1997 Dec
TI  - Hemodynamic action of captopril in coronary patients with heart failure tolerant 
      to nitroglycerin.
PG  - 999-1004
AB  - 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 > 
      or = 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.
FAU - Stork, T
AU  - Stork T
AD  - Karl Olga Krankenhaus, Department of Cardiology and Intensive Care, Stuttgart, 
      Germany.
FAU - Eichstadt, H
AU  - Eichstadt H
FAU - Mockel, M
AU  - Mockel M
FAU - Gareis, R
AU  - Gareis R
FAU - Bodemann, T
AU  - Bodemann T
FAU - Muller, R
AU  - Muller R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Vasodilator Agents)
RN  - 9G64RSX1XD (Captopril)
RN  - G59M7S0WS3 (Nitroglycerin)
SB  - IM
MH  - Aged
MH  - Angiotensin-Converting Enzyme Inhibitors/administration & dosage/adverse 
      effects/*therapeutic use
MH  - Captopril/administration & dosage/adverse effects/*therapeutic use
MH  - Coronary Disease/complications/drug therapy/*physiopathology
MH  - Drug Administration Routes
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heart Failure/complications/drug therapy/*physiopathology
MH  - Hemodynamics/drug effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nitroglycerin/administration & dosage/adverse effects/*therapeutic use
MH  - Reproducibility of Results
MH  - Safety
MH  - Treatment Outcome
MH  - Vasodilator Agents/administration & dosage/adverse effects/*therapeutic use
PMC - PMC6655751
EDAT- 1998/01/10 00:00
MHDA- 1998/01/10 00:01
PMCR- 2009/02/03
CRDT- 1998/01/10 00:00
PHST- 1998/01/10 00:00 [pubmed]
PHST- 1998/01/10 00:01 [medline]
PHST- 1998/01/10 00:00 [entrez]
PHST- 2009/02/03 00:00 [pmc-release]
AID - CLC4960201205 [pii]
AID - 10.1002/clc.4960201205 [doi]
PST - ppublish
SO  - Clin Cardiol. 1997 Dec;20(12):999-1004. doi: 10.1002/clc.4960201205.