Angiotensin‐converting enzyme inhibition and physical training in heart failure

Abstract. A total of 12 patients (mean age ± SEM 63 ± 2.6 years) with moderate to severe heart failure (ejection fraction = 23 ± 3.2%) were included in a placebo‐controlled crossover trial. Patients were randomly allocated to 4 periods of 6 weeks each: placebo, placebo and physical training, lisinopril 10 mg daily, and lisinopril and physical training. The exercise time increased from 13.6 ± 0.9 min with placebo to 15 ± 1 min with training alone, and to 16.1 ± 0.7 min with lisinopril and training. With lisinopril alone there was a nonsignificant increase in exercise time, to 14.5 ± 0.6 min. Improvements in exercise time were accompanied by a similar increase in peak oxygen consumption. Overall, the most significant improvements in symptoms and indices of cardiorespiratory fitness were achieved with a combination of lisinopril and training. Thus physical training is not only a useful adjunct to the existing medical therapy for heart failure, but it may also provide symptomatic benefits in its own right.