[Low-dose enalapril in severe chronic heart failure]

In a prospective, controlled trial, the clinical course of 40 patients with severe chronic heart failure (NYHA III-IV) was followed for 1 year. In addition to digitalis and diuretics, 20 patients were treated with low-dose enalapril (5 mg/d; group E), while the previous therapy including conventional vasodilators was continued in the other 20 patients (group K). After 1 year in group E, the functional degree of heart failure decreased significantly compared to group K (p less than 0.02): 65% of group E patients improved by at least one NYHA functional class vs only 5% in group K. Parallel to the clinical changes in group E, cardiac size decreased significantly compared to group K, when measured as either a decrease in the cardiac thoracic ratio of the chest x-ray from 0.55 +/- 0.07 to 0.52 +/- 0.11 (p less than 0.02) or in the echocardiographically determined left ventricular end-diastolic diameter from 72 +/- 9 to 65 +/- 7 mm (p less than 0.01). Severe side effects or complications occurred in 15% of the patients in group E and in 10% of group K, showing no significant difference between the two groups. During the 1-year observation period, two patients died in group E, and nine patients died in group K, resulting in a significantly (p less than 0.025) different mortality rate of 10% in group E compared to 45% in group K. Thus, additional treatment with low dose enalapril had lasting favorable influences on the clinical course of patients with severe chronic heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)