Comparison of enalapril versus digoxin for congestive heart failure

A multicenter, randomized, double-blind, parallel-group trial was conducted to compare the effects of enalapril and digoxin on clinical signs and symptoms, as well as exercise capacity, in 142 patients with congestive heart failure classified as mild to severe (New York Heart Association functional classes II to IV). The patients received optimal treatment with digitalis and diuretics for 2 to 4 weeks. Thereafter, they were randomly assigned to receive either enalapril plus diuretics (n = 72) or digoxin plus diuretics (n = 70). After 8 weeks of treatment, a significant improvement in classification was observed in 22 of 63 patients (35%) in the enalapril group and in 17 of 61 (28%) in the digoxin group (difference not significant [NS]). Similarly, duration of exercise increased in both groups (p less than 0.005; p = NS between groups). Blood pressures decreased in the enalapril group (from 129 +/- 19/80 +/- 10 to 121 +/- 20/78 +/- 11 mm Hg; p less than 0.001), but not in the digoxin group (from 134 +/- 19/82 +/- 12 to 138 +/- 19/85 +/- 10 mm Hg; NS). Serum creatinine and electrolytes did not exhibit any significant change from baseline values, except for serum potassium, which increased slightly in the enalapril group (from 4.24 +/- 0.48 to 4.43 +/- 0.49 mmol/liter; p less than 0.05) and decreased slightly in the digoxin group (from 4.28 +/- 0.47 to 4.18 +/- 0.40 mmol/liter; p less than 0.05). Adverse events were reported in 13 patients (5 withdrawals) in the enalapril group and in 7 patients (2 withdrawals) in the digoxin group (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)