ORIGINAL ARTICLE P J M H S VOL.5 NO.1 JAN – MAR 2011 125 Comparison of First Dose Hypotension with Captopril in Hypovolemic & Normovolemic Patients with Cardiac Failure ZAHID HUSSAIN SHAH, KHURRAM SALEEM, ATIF MASOOD, AURANGZEB AFZAL, ARSALAN HAIDER ABSTRACT The angiotensin converting enzyme inhibitors are the drugs of choice in congestive cardiac failure. The incidence of congestive cardiac failure is rising at the present times. Hundred patients with congestive cardiac failure either newly diagnosed or diagnosed already, but not on ACE therapy, admitted in Medical Units, Mayo Hospital, Lahore, were included in the study. Statistical analysis performed using SPSS 17.0. Results were expressed as mean ± SD. Each continuous parameter between the two groups, patients with hypovolemia/hyponatraemia and patients without hypovolemia/hyponatraemia analyzed with two tailed un-paired student’s t-test. Congestive cardiac failure is a major problem and a common disease. The ACE inhibitors have become standard therapy for heart failure. Key words: Hypotension, cardiac failure, hypovolemic & normovolemic INTRODUCTION The angiotensin converting enzyme inhibitors are the drugs of choice in congestive cardiac failure. The incidence of congestive cardiac failure is rising at the present times. The morbidity and mortality of heart failure patients is still high, even with the best techniques and management available. With the availability of drugs such as ACE inhibitors, it is now possible to antagonize the neurohormonal abnormalities caused by compensatory activation of renin angiotensin aldosterone system (RAS) and sympathetic nervous system stimulation (SNS) in patients with chronic heart failure. Clinical trials have shown that treatment regimens including these agents along with diuretics reduce the risk of deaths and hospitalization for worsening disease. Unfortunately, these drugs remain underused and frequently underdosed due to the fear of first dose hypotension, which is the most common side effect with these drugs especially captopril. This study was meant to know the incidence of first dose hypotension with ACE inhibitors (captopril) in patients with chronic heart failure (CHF). PATIENTS & METHODS Hundred patients with congestive cardiac failure either newly diagnosed or diagnosed already, but not on ACE therapy, admitted in Medical Units, Mayo Hospital, Lahore, were included in the study. Patients were divided into two groups, A and B. Group A ----------------------------------------------------------------------- Department of Medicine, King Edward Medical University/Mayo Hospital, Lahore. Correspondence to Dr. Zahid Hussain Shah, Senior Registrar, Phone 0300-9466289, Email: zahidhamdani1@hotmail.com consisted of patients which were normovolumic, not salt depleted and group B consisted of patients which were hyponatremic, volume depleted due to prior aggressive diuretic therapy. Control blood pressure readings were noted. Then test dose of captopril (6.25mg) was introduced. Blood pressure readings were noted at 30 minutes, 60 minutes and 90 minutes. First dose hypotension was observed by noting the drop in systolic blood pressure greater than 20 mmHg from the control systolic blood pressure reading after the peak effect of captopril (90 minutes) or drop in systolic blood pressure below 90 mmHg irrespective of the control reading. Patients having history of known hypersensitivity to ACE inhibitors and contraindicated for ACE inhibitors were excluded from the study. RESULTS Statistical analysis performed using SPSS 17.0. Results were expressed as mean ± SD. Each continuous parameter between the two groups, patients with hypovolemia/hyponatraemia and patients without hypovolemia/hyponatraemia analyzed with two tailed un-paired student’s t-test. Categorical data examined using the chisquarec2 test. Out of 100 patients, first dose hypotension (FDH) was observed in 36 (36%) patients after 30 minutes, 40 (40%) patients after 60 minutes and 50 (50%) patients after 90 minutes. Out of 50 patients of group A, only 10 patients showed first dose hypotension and out of 50 patients of group B, 40 patients had first dose hypotension as shown in Table 1