Safety And Tolerability Of Perindopril In Chronic Ischemic Heart Failure Patients With Low Systolic Blood Pressure

Objective: The high incidence and high mortality of heart failure have been a serious threat to human life and health,and the treatment of heart failure is still a problem worldwide.In recent years,the evidence-based medicine of heart failure proved that ACEIs is the cornerstone of heart failure treatment,but ACEIs also affect the blood pressure of patients with heart failure at the same time.As the index reflecting systemic hemodynamics,the blood pressure is closely related with the prognosis of cardiovascular diseases.According to the epidemiological statistics,there are 15%-25% heart failure patients with low systolic pressure,and the mortality of heart failure patients with low blood pressure is significantly increased.Patients with coronary heart disease may have a blood pressure of J.The aim of this clinical experiment is to observe the change of blood pressure and safety in chronic heart failure patients with low blood pressure during the period of taking small dose perindopril.Methods: We collected 81 patients who were admitted to the third department of Cardiology of The Second Hospital of Hebei Medical University from January 2015 to January 2016 and diagnosed with ischemic heart failure.After rest,salt and water intake restriction and basic treatments such as antiplatelet,lipid-lowering agents,vasodilation and diuretic,the systolic blood pressure of these patients were decreased less than 110 mmHg.There were 42 male patients(51.9%)and 39 female patients(48.1%)among them except for those who had the contraindication of applying ACEIs drugs,and their mean age was 60.52±7.62 years old.Their New York Heart Association(NYHA)was clarified II to IV and LVEF was no more than 45%.There were 37 NYHAⅡ patients(45.7%),28 NYHA Ⅲ patients(34.6%)and16 NYHA Ⅳ patients(19.7%).At first,the patients were given 2 mg ofperindopril once a day,after 2 weeks’ treatment,if no adverse reactions happened,the dose of perindopril was increased to 4 mg once a day.The dose would be decreased to previous treatment dose if the patients could not tolerate.And the follow-up time was 30 days.Monitoring index: the changes of office blood pressure,home blood pressure,24h-ambulatory blood pressure,plasma creatinine,plasma potassium and so on.Results:1 69 subjects can tolerate 4mg once a day without developing hypotension,and there is no significant decrease in blood pressure after treatment.The SBP of subjects when they left hospital(102mmHg)were decreased by 4mmHg compared with that when admitted to hospital(106mmHg),and home average SBP when they left hospital(100mmHg)were reduced by 2mmHg compared with that when admitted to hospital(102mmHg)and they showed statistical difference(106(6)vs 102(4)vs 100(4),F=91.838,P < 0.001).Comparing average DBP of be admitted to hospital,leaving hospital and staying at home(64(6)vs 64(7.5)vs 62(6),F=25.223,P<0.001),we only observed a 2mmHg decease without observing coronary events such as angina pectoris or adverse events such as angioneurotic edema.24h-ambulatory blood pressure monitoring between pre-treatment and30-day post-treatment displayed significant difference statistically.24 hSBP in pre-treatment group was decreased by 2mmHg compared with post-treatment group(102.0(6.0)vs 100.0(4.5),F=7.562,P=0.008).However,the comparision of 24 h DBP didn’t demonstrate significant difference statistically(65.0(7.5)vs63(4.5),F=3.922,P=0.052).There is no statistically significant difference in plasma creatinine and plasma potassium before and after treatment(Cr 67.4ummol/l vs 70.1ummol/l,P=0.058;K+ 4.2mmol/l vs 4.2mmol/l,P=0.192).2 8 subjects can tolerate a dose of 2mg once a day,while one subject stopped taking perindopril because of developing symptomatic hypotension at the same dose.3 The incidence of cough is 6.2% and three of them with severe drycough can not tolerate perindopril treatment.Most of them were old woman.Their average age was more than 74 years old.Conclusion:1 The majority of chronic heart failure patients with low blood pressure were able to tolerate a small dose of perindopril without developing significant hypotension-related symptoms.2 Long-term prognosis of taking small doses of perindopril for a long time in chronic heart failure patients with low blood pressure remains to be further studied.