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Enalapril for congestive heart failure.

J Kjekshus1, K Swedberg

  • 1Department of Medicine, Baerum Hospital, Norway.

The American Journal of Cardiology
|February 21, 1989
PubMed
Summary

Enalapril significantly reduced mortality in patients with severe congestive heart failure (CHF). This angiotensin-converting enzyme inhibitor improved heart function and reduced hospitalizations, despite some side effects like hypotension.

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Congestive heart failure (CHF) is a complex syndrome with high mortality.
  • Existing treatments for severe CHF (New York Heart Association class IV) include digitalis, diuretics, and vasodilators.
  • The role of angiotensin-converting enzyme (ACE) inhibitors in advanced CHF requires further investigation.

Purpose of the Study:

  • To evaluate the efficacy and safety of enalapril in patients with severe congestive heart failure (New York Heart Association class IV).
  • To assess the impact of enalapril on mortality, clinical symptoms, and hospitalizations in this patient population.

Main Methods:

  • A randomized, double-blind trial involving 253 patients with New York Heart Association class IV CHF.
  • Patients received either enalapril or placebo in addition to their standard therapy (digitalis, diuretics, vasodilators).
  • The study was prematurely discontinued due to significant differences in mortality between groups.

Main Results:

  • Enalapril significantly reduced overall mortality (p < 0.003) and mortality from progressive heart failure compared to placebo.
  • Patients receiving enalapril showed improvements in heart failure symptoms, reduced heart size, and better New York Heart Association classification.
  • Enalapril use was associated with fewer hospital admissions and reduced need for concurrent cardiovascular medications.
  • Symptomatic hypotension occurred in 17% of the enalapril group, necessitating withdrawal in some cases, but was manageable with dose reduction.

Conclusions:

  • Enalapril is highly effective in reducing mortality in patients with severe congestive heart failure (New York Heart Association class IV).
  • The benefits of enalapril extend to improved clinical status, reduced hospitalizations, and better cardiac function.
  • Careful monitoring for hypotension is recommended, especially upon initiation of therapy, with dose adjustments proving effective in mitigating this side effect.

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