Effect of the various dose of angiotensin converting enzyme inhibitor on brain natriuretic peptide and norepinephrine in patients with chronic heart failure

Objective To investigate the effect of various dosage of angiotensin converting enzyme inhibitor (ACEI) on plasma brain natriuretic peptide (BNP) and norepinephrine (NE) and the feasibility and security of high dosage of ACEI. Methods Sixty-six patients with stable chronic heart failure (CHF) who were receiving basic therapy for heart failure were randomly assigned to the low-dose group ( perindopril 2～4 mg/d) and the high-dose group (gradually increase up to perindopril 8～10 mg/d). All indices (including plasma NE and BNP levels, LVEF, LVEDd,HR,BP) were measured before and after 12w treatment, and then compared the differences between the two groups. 30 healthy subjects were selected as control group.They also were examined with the plasma levels of NE and BNP. Results The plasma BNP level was correlated closely with NYHA classes of heart failure, LVEF(r=-0.327,P=0.012),plasma NE level(r=0.402,P=0.002)and LVEDd(r=0.42,P=0.015)in patients with CHF. Both of plasma BNP and NE levels in the high-dose group (perindopril 8～10 mg/d) were decreased more than those in the low-dose group. Patients in the high-dose group received perindopril at low dosage initially and gradually increasing to the high dosage and tolerated well. Conclusion Plasma BNP level in patients with CHF is correlated closely with the severity of CHF and plasma NE. Giving perindopril to patients in the heart failure at low dosage initially and gradually increasing to the high dosage could decrease the plasma BNP and NE levels. Patients tolerated it well.