Preliminary hemodynamic report of the efficacy and safety of quinapril in acute and chronic treatment of patients with congestive heart failure.

A two-part hemodynamic trial of the efficacy and safety of quinapril hydrochloride was conducted in 26 patients with congestive heart failure (NYHA Class III or IV) who had not optimally responded to treatment with diuretics and digitalis. A total of 25 patients had evaluable data after receiving single doses (2.5, 5, or 10 mg) of quinapril. Following acute dosing, favorable hemodynamic changes began within thirty minutes to one hour and usually reached a maximum within four hours post-dose. Nineteen evaluable patients who had responded to acute therapy received an additional sixteen weeks of chronic treatment with quinapril in individualized dosage regimens. Hemodynamic responses did not differ markedly between acute and chronic therapy. Favorable hemodynamic responses were maintained or enhanced following chronic doses of 5 to 30 mg/day (given either once daily or in divided doses). The most frequent doses were 10-15 mg/day in divided doses. The mean maximum percent changes in four primary hemodynamic parameters after chronic dosing (compared with baseline) were: mean arterial blood pressure, -3.9%; pulmonary capillary wedge pressure, -39.7%; cardiac output, +31.7%; and systemic vascular resistance, -25.2%. Changes in heart rate and mean arterial blood pressure did not result in clinically significant bradycardia or hypotention. Overall, quinapril produced both acute and sustained beneficial hemodynamic effects in patients whose congestive heart failure was not clinically controlled with diuretics and digitalis.