Does captopril possess antianginal actions? An evaluation of its effects on myocardial ischemia by stress tests in patients with stable angina and normal ventricular function

Background: We have studied the effects of captopril on myocardial ischaemia in normotensive and hypertensive patients with coronary artery disease and stable effort-induced angina.

Methods: A maximal treadmill effort test (Bruce modified) was obtained before and after 60 min administration of 25 mg. p.o. of captopril. In a first open pilot essay, 12 patients were studied. In a double-blind randomized, placebo-controlled, without crossover, 20 patients with the same characteristics and methodology were divided in two groups (10 in placebo and 10 in captopril group) and compared in a maximal treadmill effort test.

Results: In the pilot essay, the second test don't showed increments in heart rate, systolic and diastolic blood pressure showed a significant reduction at rest (p < 0.01) and at 1 mV ST segment depression (p < 0.01). Captopril increased exercise duration at 1 mV ST segment depression, time to angina and total exercise time (p < 0.01). In double-blind essay, captopril group results were similar to the pilot essay. In comparing results between placebo and captopril groups the most relevant differences were: significant increment in the time to 0.1 mV ST segment depression (p < 0.01), to angor (p < 0.05) and total exercise duration (p < 0.01). Maximal work-load sustained increased significantly with captopril (7.43 +/- 2.1 to 10.34 +/- 1.8 METS) (p < 0.01).

Conclusions: We conclude that captopril used in monotherapy in patients with chronic stable angina, seems to reduce clinical and electric ischemia and to ameliorate maximal exercise duration and work-load.