The Safety of Enalapril Upward Titration in Chronic Heart Failure Akaishi Makoto 1 , Iwanaga Shiro 2 , Fukuda Keiichi 2 , Ogawa Satoshi 2 1Cardiology, Department of Internal Medicine, Kitasato Institute Hospital 2Cardiopulmonary Division, Department of Internal Medicine, School of Medicine, Keio University Keyword: エナラプリル , 慢性心不全 , 用量依存性 , enalapril , chronic heart failure , titration pp.1061-1066
Published Date 2000/10/15
DOI https://doi.org/10.11477/mf.1404902179
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We investigated the safety of enalapril, an ACE in-hibitor, upward titration in chronic heart failure withejection fraction (EF)≦0.40. Eleven patients whoreceived digitalis, diuretics and enalapril (5 mg over 4weeks) were enrolled and divided to two groups. Fourpatients were kept or enalapril 5 mg (Maintenancegroup) and seven patients were titrated upward to 10mg (Titration group). These medications werecontinued for 3 months. There were no significantchanges with regard to average values of 24h bloodpressure, average counts of ventricular premature beats,left ventricular EF, left ventricular end-diastolic dimen-sion (LVDd) and LVDs in either of the two groups.Although neurohormonal levels in the Maintenancegroup did not change significantly, brain natriureticpeptide (BNP) in the Titration group decreasedsignificantly. There were no dropout patients in theTitration group, because the upward titration of enala-pril did not decrease blood pressure and did not causeany adverse effects. Taking the results of the ATLASstudy into account, we strongly support the suggestionthat enalapril should be titrated upward in chronic heartfailure with SBP≧90 mmHg.

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