Beneficial Effect of Perindopril on Cardiac Sympathetic Nerve Activity and Brain Natriuretic Peptide in Patients With Chronic Heart Failure : Comparison With Enalapril

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Background In patients with chronic heart failure (CHF), it remains unclear whether perindopril is more car-dioprotective than enalapril. Methods and Results Forty-five stable CHF outpatients undergoing conventional therapy including enalapril therapy were randomized to 2 groups [group I (n=24): continuous enalapril treatment; group n (n=21): enalapril was changed to perindopril]. Cardiac sympathetic nerve activity was evaluated using cardiac 123I-metaiodoben-zylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and 6 months after treatment. There was no difference in baseline characteristics between the 2 groups. In group I, there were no changes in MIBG parameters, left ventricular ejection fraction (LVEF) or plasma level of brain natriuretic peptide (BNP). In contrast, in group n the delayed heart/mediastinum count ratio was significantly increased (2.0±0.07 vs 2.15+0.07, p=0.013) and the washout rate was significantly decreased (33.0±1.4 vs 30.5±1.2, p=0.030) after 6 months compared with the baseline value. In addition, LVEF was significantly increased and the plasma BNP level was significantly decreased. Conclusion These findings suggest that for the treatment of CHF, perindopril is superior to enalapril with respect of cardiac sympathetic nerve activity and BNP.
社団法人日本循環器学会の論文
2008-04-20