Beneficial effect of perindopril on cardiac sympathetic nerve activity and brain natriuretic peptide in patients with chronic heart failure: comparison with enalapril

Circ J. 2008 May;72(5):740-6. doi: 10.1253/circj.72.740.


Background: In patients with chronic heart failure (CHF), it remains unclear whether perindopril is more cardioprotective than enalapril.

Methods and results: Forty-five stable CHF outpatients undergoing conventional therapy including enalapril therapy were randomized to 2 groups [group I (n=24): continuous enalapril treatment; group II (n=21): enalapril was changed to perindopril]. Cardiac sympathetic nerve activity was evaluated using cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and 6 months after treatment. There was no difference in baseline characteristics between the 2 groups. In group I, there were no changes in MIBG parameters, left ventricular ejection fraction (LVEF) or plasma level of brain natriuretic peptide (BNP). In contrast, in group II the delayed heart/mediastinum count ratio was significantly increased (2.0+/-0.07 vs 2.15+/-0.07, p=0.013) and the washout rate was significantly decreased (33.0+/-1.4 vs 30.5+/-1.2, p=0.030) after 6 months compared with the baseline value. In addition, LVEF was significantly increased and the plasma BNP level was significantly decreased.

Conclusion: These findings suggest that for the treatment of CHF, perindopril is superior to enalapril with respect of cardiac sympathetic nerve activity and BNP.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 3-Iodobenzylguanidine
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
  • Chronic Disease
  • Enalapril / administration & dosage*
  • Female
  • Follow-Up Studies
  • Heart / innervation
  • Heart Failure / drug therapy*
  • Heart Failure / epidemiology
  • Humans
  • Iodine Radioisotopes
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Norepinephrine / blood
  • Perindopril / administration & dosage*
  • Radionuclide Imaging
  • Risk Factors
  • Stroke Volume / drug effects
  • Sympathetic Nervous System / diagnostic imaging
  • Sympathetic Nervous System / drug effects*
  • Treatment Outcome


  • Angiotensin-Converting Enzyme Inhibitors
  • Iodine Radioisotopes
  • Natriuretic Peptide, Brain
  • 3-Iodobenzylguanidine
  • Enalapril
  • Norepinephrine
  • Perindopril