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Double-blind evaluation of enalapril in patients with systolic heart failure
C Santiparpluacha1, T Yipintsoi, W Jintapakorn
1Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Insights
Adding enalapril to heart failure medication significantly reduced cardiac mortality in patients with systolic heart failure. A short-term trial of angiotensin-converting enzyme inhibitors (ACE-I) can identify patients who will benefit.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Systolic heart failure (SHF) affects numerous patients, often requiring complex management.
- Conventional treatments for SHF have limitations in improving cardiac outcomes.
Purpose of the Study:
- To evaluate the efficacy of adding enalapril to existing heart failure medication in patients with dominant systolic heart failure.
- To assess the impact of enalapril on cardiac mortality and patient improvement.
Main Methods:
- A randomized controlled trial involving 56 patients with SHF (functional class 3-4).
- Patients received either enalapril or placebo added to their standard heart failure therapy.
- A crossover design was used for a subset of patients to allow direct comparison.
Main Results:
- Cardiac mortality was lower with enalapril (32%) compared to placebo (48%).
- 80% of patients on enalapril showed improvement versus 21% on placebo when compared to a control period.
- Direct comparison showed enalapril was superior in 31% of patients, while placebo was better in 8%.
Conclusions:
- Enalapril is beneficial when added to conventional treatment for specific patients with non-valvular, non-hypertensive systolic heart failure.
- A short-term angiotensin-converting enzyme inhibitor (ACE-I) trial may be a cost-effective method to identify SHF patients who will benefit from this therapy.
Abstract:
Fifty-six patients with a mean age of 58 years, 14 females and 42 males, all with dominant systolic heart failure (33 in functional class 3 and 4) were randomised to receive either added placebo or added enalapril to their heart failure medication. There were 13 patients in this group who had their trial drug switched after a certain period to allow direct but blind comparison between placebo and enalapril. Cardiac mortality with enalapril was 32 per cent compared to 48 per cent with placebo at intervals after initiating therapy of 20.0 +/- 19.4 versus 14.3 +/- 11.5 months respectively. When compared to a preceding control period, 80 per cent of the enalapril patients improved in contrast to 21 per cent of the placebo. However, when a comparison was made directly between enalapril and placebo, enalapril was better in 31 per cent and placebo was better in 8 per cent of the patients. It is concluded that in certain patients with systolic heart failure from non-valvular and non-hypertensive causes, enalapril is beneficial when added to the conventional treatment. An argument is also presented that to cost-effectively identify the group who will benefit, a short term ACE-I trial after the conventional antifailure therapy can be considered in all patients with systolic heart failure.