Abstract
The hemodynamic actions of the systemic vasodilators parenteral sodium nitroprusside (NP) and oral captopril (CPT) were compared in 11 patients with severe chronic congestive heart failure (CHF). While the two agents produced similar reductions in mean blood pressure (NP, 90 to 70 mm Hg vs CPT, 88 to 74 mm Hg, p > 0.05) and left ventricular (LV) filling pressure (NP, 27 to 14 mm Hg vs CPT, 24 to 15 mm Hg, p > 0.05), they produced disparate effects on LV pump performance. NP raised cardiac index 35% (2.0 to 2.7 L/min/m 2, p < 0.005), whereas CPT increased this index 16% (1.9 to 2.2 L/min/m 2, p < 0.001). Concomitantly, the 31% elevation of stroke index produced by NP (26 to 34 ml/beat/m 2, p < 0.001). Simultaneously, stroke work index showed similarly greater augmentation, and total systemic vascular resistance declined more with NP. These findings suggest that oral CPT is a predominant ventricular preload-lowering agent primarily likely to improve dyspnea related to severe pulmonary congestion in patients with advanced chronic CHF.
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