[Level of angiotensin II and aldosterone in plasma is often elevated in patients with heart failure treated with converting enzyme inhibitors--preliminary results].

In large randomised trials, ACE inhibitors (ACEI) have been shown to reduce mortality, morbidity and improve quality of life in patients (pts) with congestive heart failure. However, long-term prognosis of patients in the community remains poor. It has been suggested that one of the reasons may be inadequate neuroendocrine suppression with current treatment strategies. To address this issue we measured plasma levels of angiotensin II (AII) and aldosterone (Ald) in 41 patients (36 males, mean age 52 +/- 2 y) referred to our department for diagnostic evaluation, who were treated with clinically appropriate doses of ACEI. The mean angiographic left ventricular ejection fraction was 22 +/- 8%, left ventricular end diastolic diameter was 72 +/- 10 mm, and NYHA class was 2.6 +/- 0.7. Plasma levels of All and Ald were measured by radioimmunoassay. They did not differ significantly in comparison with the control group of 5 healthy individuals (4.8 +/- 8.2 pg/ml vs 4.1 +/- 3.2 pg/ml for angiotensin II and 129 +/- 93 pg/ml vs 78 +/- 29 pg/ml for aldosterone). A high variability of the results was seen between the individual patients. Full suppression of All (< 2.0 pg/ml) was achieved in 21 patients (58%), 10 pts (28%) showed intermediate levels (2.0-10.0 pg/ml), and 5 patients (14%) demonstrated markedly increased All levels (> 10 pg/ml). Full suppression of Ald (< 80 pg/ml) was seen in only 15 patients (37%), 14 patients (34%) had intermediate levels (80-140 pg/ml) and 12 patients (29%) showed high plasma levels of Ald (> 140 pg/ml). There was a weak, but significant, correlation between All and Ald levels in the study group (r = 0.49, p < 0.05). These preliminary results suggest inadequate neuroendocrine suppression in a substantial proportion of patients, despite using clinically relevant doses of ACE inhibitors. The determination of All and Ald levels may be a helpful tool in monitoring the efficacy of treatment in CHF and may help identify patients who would benefit from other treatment strategies.