EFFECTS OF CAPTOPRIL AND ISOSORBIDE DINITRATE ON HEMORHEOLOGICAL PARAMETERS IN PATIENTS WITH CHRONIC CONGESTIVE-HEART-FAILURE DUE TO CORONARY HEART-DISEASE

The aim of the present study was to investigate the hemorheological effects of captopril and isosorbide dinitrate (ISDN) in patients with chronic congestive heart failure (CHF) due to coronary heart disease (CHD). 51 patients were enrolled in this double-blind, randomised, comparative trial. All patients had a left ventricular ejection fraction of less than 40% corresponding to NYHA-class II or III, and were on a baseline regimen with diuretics. During the 3-week run-in phase, treatment with captopril was initiated up to a daily dosage of 2x25 mg. Then all patients were randomised to receive either ISDN (2x40mg/day) or placebo over a 16-weeks double-blind phase. We were able to demonstrate a significant decrease of plasma viscosity (p < 0.05) and white blood cell count (p < 0.01) during treatment with captopril. The additional treatment with ISDN did not lead to further changes in the hemorheological profile. In conclusion ACE-inhibition with captopril leads to a moderate improvement of blood theology in patients with CHF due to CHD. Nitrates added to a baseline treatment with captopril and diuretics do not further improve blood theology. This may be explained by the pronounced vasodilatory effect of captopril due to inhibition of angiotensin II and increased levels of bradykinin.