To assess the short- and long-term hemodynamic efficacy of perindopril, 15 patients (12 men and 3 women) diagnosed with congestive heart failure were treated with oral perindopril (4 mg daily) for 3 months in association with digitalis and diuretic maintenance therapy. Patients were in New York Heart Association (NYHA) functional classes III and IV. Underlying cardiopathy was ischemic (6 patients), hypertensive (5 patients), valvular (2 patients), and dilated cardiomyopathy (2 patients). Hemodynamics, angiotensin-converting enzyme (ACE) activity, and perindoprilat (the active metabolite of perindopril) blood titration were measured at 2 periods. Acute assessment was performed over 2 titration days on oral perindopril 2 mg (day 1) and 4 mg (day 2); measurements were performed at rest and at 0, 1, 4, 6, 8, 12, and 24 hours. Chronic assessment was performed after 3 months of treatment with oral perindopril, 4 mg daily. During the study, 1 patient withdrew due to low systolic blood pressure (< 100 mm Hg) and 3 severely impaired patients died due to a worsening of heart failure during the study. Among the 11 remaining patients, 6 were symptomatically improved. On 4 mg perindopril administration, hemodynamic improvement was similar for peak values at both day 2 and at 3 months. At day 2, compared with baseline, cardiac index increased by 21% (p < 0.05) and pulmonary capillary wedge pressure (PCWP) and mean arterial pressure (MAP) decreased by 54% and by 21%, respectively (p < 0.01). Similarly, at 3 months, cardiac index increased by 37% (p < 0.001) and PCWP and MAP decreased by 41% and 19%, respectively (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)