Incidence and risk factors of asymptomatic first-dose hypotension with angiotensin-converting enzyme inhibitors in chronic heart failure due to systolic dysfunction.
Indian Heart J
;
2003 Mar-Apr; 55(2): 167-71
Article
in English
| IMSEAR
| ID: sea-4945
ABSTRACT
BACKGROUND:
In practice, chronic heart failure is often not treated with angiotensin-converting enzyme inhibitors. One reason is the fear of first-dose hypotension. In the majority of patients, this condition is asymptomatic and the consequences are unexpected. Presently, little is known of its epidemiology. METHODS ANDRESULTS:
This was a prospective, 48-hour observational study of 160 patients with chronic heart failure due to systolic dysfunction, previously untreated with angiotensin-converting enzyme inhibitors, randomly drawn from the clinical practice of selected cardiologists across India. The primary outcome was a change in the mean arterial pressure during the first 24-hours after the first dose of an angiotensin-converting enzyme inhibitor. In 131/160 patients (81.9%) with no hypotensive symptoms, the incidence of first-dose hypotension (maximum 24-hour fall in mean arterial pressure greater than 10% from baseline) was 56/131 (42.7%). Pre-treatment diastolic pressure had a negative, independent association with 24-hour change in mean arterial pressure, accounting for 29% (R2=0.29, p<0.01) of its variability, and its predictive value was greater with pro-drug angiotensin-converting enzyme inhibitors. The incidence of first-dose hypotension increased from 1 patient (4.8%) at a pre-treatment diastolic pressure of 50-70 mmHg to 35 patients (42.7%) at 71-90 mmHg, p<0.01.CONCLUSIONS:
The incidence of first-dose hypotension with angiotensin-converting enzyme inhibitors in outpatients with chronic heart failure due to systolic dysfunction is high. Pre-treatment diastolic pressure is an independent risk factor, and its predictive value increases with pro-drug angiotensin-converting enzyme inhibitors. This could help physicians to anticipate asymptomatic first-dose hypotension and increase the utilization of these agents in heart failure.
Full text:
Available
Index:
IMSEAR (South-East Asia)
Main subject:
Stroke Volume
/
Aged
/
Female
/
Humans
/
Male
/
Angiotensin-Converting Enzyme Inhibitors
/
Chronic Disease
/
Incidence
/
Prospective Studies
/
Risk Factors
Type of study:
Controlled clinical trial
/
Etiology study
/
Incidence study
/
Observational study
/
Prognostic study
/
Risk factors
Country/Region as subject:
Asia
Language:
English
Journal:
Indian heart j
Year:
2003
Type:
Article
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