Captopril-furosemide survival study in experimental heart failure.

The strategy of diuretic drug administration remains to be defined in heart failure as experimental and clinical evidence have clearly established the benefit of neurohormonal blockade. The impact of addition of diuretic treatment to angiotensin-converting enzyme inhibition on survival remains to be demonstrated. The objectives of the study were to evaluate cardiovascular and renal effects of addition of diuretic treatment to captopril (2 g/L, in drinking water), on survival, on the experimental model of heart failure. Rats were followed for 10 months after coronary ligation. Echocardiographic, hemodynamic, morphometry and renal function investigations were then performed on surviving rats. Survival (from 34 to 61%), diuresis and natriuresis were significantly improved compared to control group only in animals treated with a combination of captopril + furosemide. In treated group: cardiac dimensions were reduced with left ventricular fractional shortening significantly increased in combination group (from 22.4 to 28%); captopril + furosemide animals had highest heart rate and lowest systolic and diastolic blood pressures; body and heart weight were reduced, but kidney weight was significantly increased with furosemide (1.7 g in control vs. 2 g in capto + furo); plasma renin activity and angiotensin 1 were greatly increased, and moderately stimulated in control. In conclusion, this combination of drugs significantly improved cardiac remodeling and survival of animals, increased diuresis and natriuresis despite stimulation of plasma renin activity and kidney hypertrophy.