imidapril and Ventricular-Dysfunction--Left

To review whether brain natriuretic peptides (BNP) can be used as a surrogate for the traditional methods of assessing functional status in interventional studies of patients with left ventricular systolic dysfunction (LVSD).. The traditional methods for assessing functional status including New York Heart Association (NYHA) class, exercise intolerance and quality of life were reviewed in relation to BNP measurements in patients with LVSD. A meta-analysis of four studies evaluating BNP levels versus exercise peak oxygen uptake or 6-minute walking distance showed a significant correlation, but a low R-value of -0.59. Studies using BNP levels for optimisation of heart failure therapy showed conflicting results concerning the correlation between the functional improvement and changes in BNP levels. Conflicting results were also found concerning the utility of BNP levels as a surrogate to predict efficacy of the various anti-congestive therapies on heart failure outcome.. The results of the studies examining BNP measurement as a surrogate for functional status and drug efficacy in patients with LVSD are conflicting. Further studies are necessary to settle the place of BNP measurement as surrogate marker for exercise tolerance, NYHA classification and in assessing efficacy of different interventions in the clinical trials.

Topics: Angiotensin-Converting Enzyme Inhibitors; Biomarkers; Carbazoles; Carvedilol; Clinical Trials as Topic; Data Collection; Drug Administration Schedule; Enalapril; Exercise Test; Exercise Tolerance; Health Status; Heart Failure; Humans; Imidazolidines; Meta-Analysis as Topic; Metoprolol; Natriuretic Peptide, Brain; Propanolamines; Quality of Life; Statistics as Topic; Treatment Outcome; Ventricular Dysfunction, Left

Symptoms of cancer cachexia (CC) include fatigue, shortness of breath, and impaired exercise capacity, which are also hallmark symptoms of heart failure (HF). Herein, we evaluate the effects of drugs commonly used to treat HF (bisoprolol, imidapril, spironolactone) on development of cardiac wasting, HF, and death in the rat hepatoma CC model (AH-130).. Tumour-bearing rats showed a progressive loss of body weight and left-ventricular (LV) mass that was associated with a progressive deterioration in cardiac function. Strikingly, bisoprolol and spironolactone significantly reduced wasting of LV mass, attenuated cardiac dysfunction, and improved survival. In contrast, imidapril had no beneficial effect. Several key anabolic and catabolic pathways were dysregulated in the cachectic hearts and, in addition, we found enhanced fibrosis that was corrected by treatment with spironolactone. Finally, we found cardiac wasting and fibrotic remodelling in patients who died as a result of CC. In living cancer patients, with and without cachexia, serum levels of brain natriuretic peptide and aldosterone were elevated.. Systemic effects of tumours lead not only to CC but also to cardiac wasting, associated with LV-dysfunction, fibrotic remodelling, and increased mortality. These adverse effects of the tumour on the heart and on survival can be mitigated by treatment with either the β-blocker bisoprolol or the aldosterone antagonist spironolactone. We suggest that clinical trials employing these agents be considered to attempt to limit this devastating complication of cancer.

Topics: Adrenergic beta-1 Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Animals; Bisoprolol; Body Composition; Body Weight; Cachexia; Glycogen Synthase Kinase 3; Heart Failure; Imidazolidines; Liver Neoplasms; Mineralocorticoid Receptor Antagonists; Myocytes, Cardiac; Myosin Heavy Chains; Rats; Signal Transduction; Spironolactone; Survival Analysis; Ventricular Dysfunction, Left; Wasting Syndrome

Imidapril is an angiotensin converting enzyme (ACE) inhibitor without a sulfhydril group which has been shown from previous study to have low incidence of ACE inhibitor induced cough.. To compare the incidence of cough between two ACE inhibitors, imidapril and enalapril.. A comparative cross over study was performed in 119 patients with hypertension or left ventricular dysfunction. Patients were assigned to one of the two treatment groups, either a group receiving imidapril or enalapril for 4 weeks (Period I) and then these same groups were crossed over to receive either enalapril or imidapril for 4 weeks (Period II). The occurrence of cough during treatment was monitored by interviewing the patients.. The incidence of cough was 44 % while on imidapril treatment and 66% while on enalapril treatment (p = 0.0014). The antihypertensive effects of two drugs were not different.. The incidence of cough was significantly less under imidapril than under enalapril treatment, while there was no difference in the antihypertensive effects between the two ACE inhibitors.

Topics: Administration, Oral; Aged; Angiotensin-Converting Enzyme Inhibitors; Cough; Cross-Over Studies; Enalapril; Female; Humans; Hypertension; Imidazolidines; Incidence; Male; Middle Aged; Treatment Outcome; Ventricular Dysfunction, Left