Relation between serum sodium concentration and the hemodynamic and clinical responses to converting enzyme inhibition with captopril in severe heart failure
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Abstract
The relation between pretreatment serum sodium concentration and the early and late
effects of captopril was examined in 77 consecutive patients with severe chronic heart
failure, in whom cardiac catheterization was performed during initiation of treatment
and after 2 to 8 weeks. Two groups of patients were defined: 37 patients had hyponatremia
(serum sodium less than 135 mEq/liter, group A) and 40 patients had a normal serum
sodium concentration (greater than or equal to 135 mEq/liter, group B). With first
doses of captopril, patients in group A showed more marked hemodynamic responses than
did patients in group B (p less than 0.02). The changes in mean arterial pressure
and left ventricular filling pressure seen with first doses of the drug varied linearly
and inversely with the pretreatment serum sodium concentration (r = -0.58 and r =
-0.53, respectively); this was likely related to the finding that, before administration
of captopril, the serum sodium concentration varied linearly and inversely with the
logarithm of the plasma renin activity (r = -0.78). However, the pretreatment serum
sodium concentration did not predict the long-term hemodynamic or clinical responses
to converting enzyme inhibition. Symptomatic hypotension occurred early in the course
of therapy (within 24 hours of initiating captopril therapy) in 9 (12%) of the 77
patients; 8 of these 9 had severe hyponatremia (serum sodium less than 130 mEq/liter)
and comprised 53% of the 15 patients in our study with such low serum sodium concentrations.(ABSTRACT
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