The Hydralazine Captopril Trial - Hy-C

Description:

Captopril vs. hydralazine/nitrates for mortality in severe heart failure.

Hypothesis:

Direct comparison of regimens for survival in heart failure.

Study Design

Study Design:

Patients Screened: Not given
NYHA Class: III=(21%), IV=(79%)
Mean Follow Up: 8 months
Mean Patient Age: 52
Female: 14
Mean Ejection Fraction: 20%

Patient Populations:

Severe congestive heart failure with left ventricular dysfunction and hemodynamic compromise
NYHA Class II-IV despite digitalis, diuretics and empiric doses of vasodilators

Exclusions:

Myocardial infarction prior two months
Unstable angina
Right heart failure due to pulmonary disease
Restrictive cardiomyopathy
Creatinine > 2.5
Co-morbid condition limiting one year survival

Primary Endpoints:

Mortality

Drug/Procedures Used:

Captopril (titrated to hemodynamic goals)
Hydralazine (titrated to hemodynamic goals)

Concomitant Medications:

Isosorbide dinitrate
Class I antiarrhythmic agents
Amiodarone, digoxin, loop diuretics, metolazone

Principal Findings:

One year survival was 81% in Captopril group and 51% in hydralazine group (p = 0.05).
Reduced sudden death in Captopril group; actuarial rates 5% for Captopril and 37% for hydralazine (p = 0.01).
Independent predictors of survival = low pulmonary wedge pressure, therapy with Captopril.

Interpretation:

"This study demonstrates that the angiotensin converting enzyme inhibitor Captopril confers an additional benefit over that achieved by direct vasodilation with hydralazine when doses are titrated to achieve the same hemodynamic goals and nitrates are included in both regimens." (From Abstract)

References:

1. J Am Coll Cardiol 1992;842-50. Final results

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Pulmonary Wedge Pressure, Hydralazine, Vasodilation, Nitrates, Diuretics, Heart Failure, Death, Sudden, Digitalis, Ventricular Dysfunction, Left, Captopril, Vasodilator Agents


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