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Influence of Renal Function on the Hemodynamic and Clinical Responses to Long-Term Captopril Therapy in Severe Chronic Heart Failure

MILTON PACKER, M. D.; WAI HUNG LEE, M.D.; NORMA MEDINA, R.N.; and MADELINE YUSHAK, R.N.
[+] Article and Author Information

Grant support: Dr. Packer is the recipient of a Research Career Development Award K04-HL-01229 from the National Heart, Lung, and Blood Institute.

▸ Requests for reprints should be addressed to Milton Packer, M.D.; Division of Cardiology, Mount Sinai Medical Center, One Gustave Levy Place; New York, NY 10029.


New York, New York


©1986 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1986;104(2):147-154. doi:10.7326/0003-4819-104-2-147
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To evaluate the influence of renal function on the efficacy of converting-enzyme inhibition in patients with severe chronic heart failure, we measured the long-term hemodynamic and clinical responses to Captopril in 101 consecutive patients with heart failure grouped according to pretreatment serum creatinine concentration (group I, < 1.4 mg/dL; group II, 1.4 to 2.8 mg/dL; and group III, > 2.8 mg/dL). After 1 to 3 months of treatment, patients with preserved renal function (group I) had greater increases in stroke volume index and greater decreases in left ventricular filling pressure and systemic vascular resistance than did patients with renal impairment (groups II and III) (p < 0.05). Clinical improvement paralleled these hemodynamic benefits; only 2 of 12 patients with severe renal insufficiency (group III) improved clinically compared with 29 of 40 patients with preserved renal function (group I) and 29 of 49 patients with mild-to-moderate renal impairment (group II), (p < 0.005). Therapy-limiting rash and dysgeusia occurred most frequently in patients with renal impairment. Our findings support an important role for the kidneys in mediating the beneficial actions of Captopril in patients with severe congestive heart failure.

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