1999 - We studied 45 patients (43 men and 2 women) aged 33 to 74 years with an average EF of 28%. At study start, exercise capacity was poor and neurohormone levels were high.
The dose of enalapril (Vasotec) at study start was either 5mg BID (16 patients), 10mg BID (18 patients), or 20mg BID (11 patients). All patients were treated for 4 weeks with each different dose.
There were no changes in heart class, shortness of breath when lying down, or edema . However, patients had more CHF symptoms on low doses (10mg) than when taking higher doses. Neurohormone levels were 25% higher when patients were on the low dose. Vo2max increased when patients were on the highest dose - a good thing.
Higher ACE inhibitor dose improves daily functioning and lowers blood levels of harmful hormones in CHF patients. Patients had less CHF symptoms on the highest dose. Serious adverse events happened more often on lower doses.
Angiotensin II causes great harm in CHF patients over time. During long-term therapy, angiotensin II receptors in the body may become more sensitive, so lowering blood levels of it is important. High dose ACE inhibitor improves not only CHF symptoms and exercise ability, but also reduces chemicals that worsen CHF. Heart failure patients benefit from higher doses of ACE inhibitors .
Title: Within-Patient Comparison of Effects of Different Dosages of Enalapril on Functional Capacity and Neurohormone Levels in Patients With Chronic Heart Failure
Authors: H. Brunner-La Rocca, D. Weilenmann, W. Kiowski, E. Maly, R. Candinas, F. Follath
Source: Am Heart J 138(4):654-662, 1999
Pediatric patients greater than or equal to 6 years of age:
Initial dose: mg/kg orally once a day (Maximum initial dose is 5 mg once a day)
Maintenance dose: Dosage should be adjusted according to blood pressure response at 1 to 2 week intervals.
Maximum dose: Doses above mg/kg or greater than 40 mg have not been studied in pediatric patients
-This drug is not recommended in pediatric patients less than 6 years old or in pediatric patients with glomerular filtration rate less than 30 mL/min.
In most trials, the antihypertensive effect of ALTACE increased during the first several weeks of repeated measurements. The antihypertensive effect of ALTACE has been shown to continue during long-term therapy for at least 2 years. Abrupt withdrawal of ALTACE has not resulted in a rapid increase in blood pressure. ALTACE has been compared with other ACE inhibitors, beta-blockers, and thiazide diuretics. ALTACE was approximately as effective as other ACE inhibitors and as atenolol. In both Caucasians and Blacks, hydrochlorothiazide (25 or 50 mg) was significantly more effective than ramipril.