Low-dose enalapril in severe chronic heart failure.
In a 3-month prospective, single-blind, controlled trial, 38 patients in New York Heart Association functional class III-IV were assigned to group E (n = 19): enalapril 5 mg/day in addition to the previous therapy with digitalis and diuretics, or group C (n = 19): continuation of the previous therapy. In group E, 79% of the patients improved by at least one NYHA functional class after 3 months. In group C, the functional class did not change and four patients died. The echocardiographically determined end-diastolic diameter of the left ventricle decreased in group E from 72 +/- 8 mm to 63 +/- 6 mm (p less than 0.001), and the scintigraphically determined ejection fraction of the left ventricle increased from 33 +/- 18% to 40 +/- 19% (p less than 0.002). In contrast, no significant change was found in group C. Plasma-renin activity increased in group E from 8.2 +/- 1.8 ng/ml h to 29.7 +/- 14 ng/ml h (p less than 0.001), and plasma aldosterone decreased from 47.7 +/- 7.6 ng/dl to 19.9 +/- 4.8 ng/dl (p less than 0.01). In group C no significant change occurred. Comparing the actual changes (deltas) of the NYHA functional class (p less than 0.02), end-diastolic diameter and ejection fraction of the left ventricle, plasma-renin activity, and plasma aldosterone (p less than 0.0001), a significant difference between the two groups was found. Thus, low-dose enalapril resulted in a significant improvement of the NYHA functional class in patients with severe chronic heart failure, accompanied by an improvement in left ventricular function and a decrease in secondary aldosteronism.
Brilla
C G
CG
University of Chicago, Michael Reese Hospital and Medical Center, IL 60616.
Krämer
B
B
Hoffmeister
H M
HM
Müller-Schauenburg
W
W
Risler
T
T
Seipel
L
L
D000368:Aged; D000450:Aldosterone / Q000097:blood; D002908:Chronic Disease; D004562:Electrocardiography; D004656:Enalapril / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006334:Heart Function Tests; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D012083:Renin / Q000097:blood; D016037:Single-Blind Method
D000450:Aldosterone; D004656:Enalapril; D012083:Renin