Outcome of Patients With Congestive Heart Failure Treated With Standard Vs. High Doses of Enalapril: A Multicenter Study - Enalapril: Outcome of Patients With Congestive Heart Failure Treated With Standard Vs. High Doses
Outcome of Patients With Congestive Heart Failure Treated With Standard Vs. High Doses of Enalapril: A Multicenter Study
The authors conducted a prospective randomized survival study in patients with congestive heart failure (CHF). Patients were treated with standard vs. high doses of enalapril, with assessment of clinical and hemodynamic variables.
Patients Enrolled: 248
Two hundred forty-eight patients with advanced CHF (age 56.3 +/- 12 years) were randomized. They received enalapril, up to 20 mg/day in group 1 (mean dose achieved 17.9 +/- 4.3 mg/day, n = 122) and 60 mg/day in group 2 (mean dose achieved 42 +/- 19.3 mg/day, n = 126). Other medications were given in standard doses as clinically required.
There were no significant differences in clinical, renal and ventricular characteristics between the two groups of patients at enrollment. After 12 months of follow-up, 22 (18%) of 122 patients in group 1 and 23 (18%) of patients in group 2 had died (p = 0.995, with 80% power of the study to detect a delta difference of 13%). The NYHA class was the same in both groups. There were no significant differences of blood pressure, heart rate, or ejection fraction between the two groups. Renal function likewise was similar for the two groups.
No significant differences were found in survival and clinical and hemodynamic variables between patients receiving standard and those receiving high doses of enalapril.
Based on these observations, the authors indicate that a standard dose of enalapril at 20 mg daily is sufficient therapy for heart failure. The study was not sufficiently powered to extrapolate the comparable survival outcome however. It was interesting to note that there was no adverse renal effect of high-dose enalapril, which indicates that higher doses, if necessary, seem to be well tolerated.
Nanas JN, Alexopoulos G, Anastasiou-Nanam MI, et al. J Am Coll Cardiol 2000;36:2090-5.
Keywords: Enalapril, Heart Failure, Blood Pressure, Heart Rate
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