COMBINED THERAPY OF CAPTOPRIL AND SPIRONOLACTONE FOR REFRACTORY CONGESTIVE-HEART-FAILURE

Citation
Yl. Han et al., COMBINED THERAPY OF CAPTOPRIL AND SPIRONOLACTONE FOR REFRACTORY CONGESTIVE-HEART-FAILURE, Chinese medical journal, 107(9), 1994, pp. 688-692
Citations number
14
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Medicine, General & Internal
Journal title
ISSN journal
0366-6999
Volume
107
Issue
9
Year of publication
1994
Pages
688 - 692
Database
ISI
SICI code
0366-6999(1994)107:9<688:CTOCAS>2.0.ZU;2-R
Abstract
It is traditionally considered that angiotensin-converting enzyme inhi bitor (ACEI) and spironolactone could not be used simultaneously becau se of the assumed risk of hyperkalemia. However, despite ACEI therapy edema and,congestive status remain in some of the patients with severe congestive heart failure (CHF). In order to seek an effective therapy for these patients, we observed the efficacy and safety of captopil p lus spironolactone in patients vith refractory CHF, with strict monito ring of renal function, serum and urine electrolytes and blood pressur e (BP). Thirty-five patients with refractory CHF and New York Heart As sociation functional class IV without renal dysfunction, hypotension a nd hyperkalemia, whose plasma aldosterone (ALD) level in 88.6% of them was above normal value, were randomly assigned to group A (n=16, capt opril alone) and B (n=19, captopril plus spironolactone) for a 4-week treatment. The dosage of both druges was individually adjusted in time according to the results of serum potassium and renal function. The i mprovement in dyspnea-fatigue ratings, urinary volume and Na+/K(-)rati o in group B was more Significant than that in group A, and the plasma ALD level in group B decreased obviously while it remained high in gr oup A after therapy. Two patients in group B who had had mormal plasma ALD level with urinary Na-/K(-)ratio > 1.0 before the therapy did not exhibit any clinical improvement. A strong negative correlation was f ound between plasma ALD. level and urinary Na+/K(-)ratio (correlation coefficient -0.689, P<0.01). None of the patients had obvious hyperkal emia and hypoaldosteronism. The present results showed that the effect s of captopril plus spironolactone exceeded those of captopril alone i n treating refractory CHF patients who had normal renal function, and that high plasma ALD level and urinary Na+/K(+)ratio < 1.0 in patients with severe CHF may serve as an indication for combined therapy. Side effects could be prevented if individualized dosage adjustment was ma de in time according to the monitoring results of serum potassium, ren al function and BP.