Relation of the Renin-Angiotensin-Aldosterone System

The status of the renin-angiotensin-aldosterone system (RAAS) in congestive heart failure (CHF) varies in many reports, in part because of the heterogeneity of the clinical status of the patients studied. To relate the RAAS to clinical state, we studied 23 patients with severe CHF (New York Heart Association functional classes III-IV): five had recent onset of severe pump failure with pulmonary edema (group 1), nine had recent cardiac decompensation superimposed on chronic CHF (group 2) and nine had chronic stable CHF (group 3). The severity of cardiac dysfunction in patients in group 3 was comparable to that in the other two groups (cardiac index, 1.6 ± 0.2 1/min/m2; ejection fraction, 19.3 ± 3%). Pulmonary wedge pressure was similar in all groups (29 ± 3, 28 ± 2 and 29 ± 5 mm Hg). Groups 1 and 2 had reduced mean blood pressure (71

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