PMID- 9470059
OWN - NLM
STAT- MEDLINE
DCOM- 19980506
LR  - 20131121
IS  - 0046-5968 (Print)
IS  - 0046-5968 (Linking)
VI  - 27
IP  - 12
DP  - 1997 Dec
TI  - Captopril plus losartan in early post-infarction. Neurohormonal effects: a pilot 
      study.
PG  - 1256-63
AB  - BACKGROUND: Suppression of the formation of angiotensin II (A II) is thought to 
      be a major contributor to the hemodynamic response to angiotensin-converting 
      enzyme inhibition (ACE-inhibitor) therapy. However, during ACE-inhibitor 
      treatment, A II plasma levels may also recover through tissue chymase. This study 
      has attempted to verify the feasibility, safety and tolerability of a combined 
      treatment using captopril (75 mg/day) and losartan (25 mg/day), and to ascertain 
      its ability to reduce the formation and action of A II in the early 
      post-infarction phase of reperfused anterior myocardial infarction (AMI). METHOD: 
      Forty-four patients hospitalized for suspected AMI within 4 hours of the onset of 
      symptoms, who were suitable for thrombolysis (first episode), in Killip class 
      I-II, reperfused, treated with 75 mg/day of captopril within 3 days of admission 
      and with a blood pressure level of more than 120 mmHg, were randomized 
      (single-blind) into two groups that were similar with regard to age, sex, blood 
      pressure, CK peak, ejection fraction, end-systolic volume and risk factors. Group 
      A (22 subjects: 6 women/16 men) received captopril (75 mg/day) and placebo, while 
      group B (22 subjects: 5 women/17 men) was given captopril (75 mg/day) plus 
      losartan, initially at 12.5 mg and then at 25 mg/day thereafter (BP > 110 mmHg). 
      Norepinephrine (NE) and A II plasma levels were measured on the third and tenth 
      day after admission. RESULTS: Ten days after admission, group B (captopril plus 
      losartan) showed a significant decrease in blood pressure (BP) on an intragroup 
      level (p < 0.001) as well as in comparison with group A (p < 0.001), with values 
      of 108 + 6.4 and 118 + 11 mmHg respectively. At the same time interval, NE and A 
      II values did not show significant differences within or between groups. 
      CONCLUSIONS. For the first time, our data suggest that a combined 
      captopril-losartan treatment is feasible and that it has no particular side 
      effects. In addition, it shows no significant increase of A II that would be 
      produced by losartan alone.
FAU - Di Pasquale, P
AU  - Di Pasquale P
AD  - Coronary Care Unit, Ingrassia Hospital Palermo.
FAU - Cannizzaro, S
AU  - Cannizzaro S
FAU - Longo, A M
AU  - Longo AM
FAU - Maringhini, G
AU  - Maringhini G
FAU - Iachininoto, R
AU  - Iachininoto R
FAU - Paterna, S
AU  - Paterna S
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - Italy
TA  - G Ital Cardiol
JT  - Giornale italiano di cardiologia
JID - 1270331
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 11128-99-7 (Angiotensin II)
RN  - 9G64RSX1XD (Captopril)
RN  - JMS50MPO89 (Losartan)
RN  - X4W3ENH1CV (Norepinephrine)
SB  - IM
MH  - Aged
MH  - Angiotensin II/blood/drug effects
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Captopril/*administration & dosage
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Losartan/*administration & dosage
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/blood/*drug therapy
MH  - Norepinephrine/blood
MH  - Pilot Projects
MH  - Single-Blind Method
MH  - Time Factors
EDAT- 1998/02/21 00:00
MHDA- 1998/02/21 00:01
CRDT- 1998/02/21 00:00
PHST- 1998/02/21 00:00 [pubmed]
PHST- 1998/02/21 00:01 [medline]
PHST- 1998/02/21 00:00 [entrez]
PST - ppublish
SO  - G Ital Cardiol. 1997 Dec;27(12):1256-63.