Abstract
Background: Experimental data suggest a superiority of ACE inhibitors with high tissue affinity over those with low tissue affinity. No direct comparison has been carried out in a clinical trial to date. Accordingly, we randomized 30 patients with systolic CHF (LVEF <40%) to receive 40 mg daily of enalapril (low tissue affinity, ENAL) or 4 mg daily of trandolapril (high tissue affinity, TRAN) for 8 weeks. Methods: ENAL was uptitrated to 40 mg daily or the maximally tolerated dose. After a 4 week run-in period on the achieved dose, the activity of the vascular and circulating renin-angiotensin system (RAS) was assessed by the pressor response to exogenous angiotensin I (Ang I) and plasma Ang II levels, respectively.
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