Survival in patients with heart failure: focus on captopril

Congestive heart failure is a serious health-care problem that is associated with a high mortality. Although drug therapy has been effective in reducing symptoms, until recently there has been little evidence of prolonged survival. Within the past few years, however, certain vasodilator therapies, when added to a conventional regimen, have demonstrated a positive effect on longevity. In patients with moderately severe to severe heart failure, the combination of isosorbide dinitrate and hydralazine reduced mortality by 34%. In patients with severe heart failure, enalapril reduced one-year mortality by 31%. Captopril has also been shown to be effective in improving survival. In a recent analysis, the mortality rate of patients with moderately severe heart failure treated with captopril was 4% over three months, compared with 21% among placebo-treated patients. In a smaller study, 83% of captopril-treated patients, compared with 20% of hydralazine-treated patients, with moderately severe to severe heart failure survived for at least one year. The mechanisms through which captopril could potentially improve survival include hemodynamic, functional, structural, and neurohormonal variables.