Angiotensin-converting enzyme inhibitors and β-blockers in long-term treatment of dilated cardiomyopathy

• Published in: The American heart journal 1995-04, Vol.129 (4), p.754-761
• Main Authors: Regitz-Zagrosek, Vera, Leuchs, Berndt, Krülls-Münch, Jürgen, Fleck, Eckart
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Cardiac Catheterization; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - drug therapy; Cardiomyopathy, Dilated - epidemiology; Double-Blind Method; Echocardiography; Electrocardiography, Ambulatory; Enalapril - therapeutic use; Exercise Tolerance - drug effects; Female; Hemodynamics - drug effects; Humans; Male; Metoprolol - therapeutic use; Middle Aged; Prospective Studies; Time Factors; Ventricular Function - drug effects
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(95)90326-7

This double-blind, randomized, long-term study investigated the effects of the angiotensin-converting enzyme inhibitor enalapril and the β-blocker metoprolol on clinical, hemodynamic, angiographic, and neurohomronal parameters in patients with dilated cardiomyopathy and moderate cardiac functional impairment (left ventricular ejection fraction [LVEF] 35% ± 6%). After 12 months of treatment, a 12% reduction in 24-hour heart rate was observed in both groups ( p < 0.05), whereas heart rate during exercise was reduced only in the metoprolol group. Echocardiographic fractional shortening increased (enalapril: 17% ± 6% to 21% + 7%; metoprolol: 21% ± 9% to 29% ± 7%; both p < 0.05), as did not angiographic LVEF (enalapril: 35% ± 7% to 43% ± 12%, p = 0.1; metoprolol: 34% ± 7% to 44% ± 9%, p < 0.05), whereas ventricular volume decreased. Initially, both groups were comparable in terms of all parameters investigated. After 12 months fractional shortening was greater, and the heart rate at 50 W was lower in the β-blocker group. At the doses used, the effect of the β-blocker on dilated cardiomyopathy with moderate functional impairment was at least as great as that of the angiotensin-converting enzyme inhibitor.