title: [The ATLAS study (Assessment of Treatment with Lisinopril and Survival); justification and objectives].
abstract: Treatment with ACE inhibitors has improved the prognosis of cardiac failure (CF). The results of CONSENSUS I, SOLVD and V HEFT II show clinical improvement and longer survival with this therapeutic class of drugs. However, the search for the optimal dosage was not undertaken in these trials (a standard dose was fixed at the onset, average dose of enalapril from 15 to 20 mg/day). In clinical practice, patients are prescribed lower doses of ACE inhibitors (enalapril: 7.5 mg/day) than the averages used in large scale trials. In order to optimise the use of ACE inhibitors, the ATLAS study (Assessment of Treatment with Lisinopril and Survival) was undertaken with the precise objective of comparing two dosages (2.5 to 5 mg/day vs 32.5 to 35 mg/day) of lisinopril on the morbidity and mortality of patients with CF. This international, multicenter, randomised, double-blind parallel group trial aims to include 3,000 patients over 18 years of age with NYHA Classes II, III and IV, and an ejection fraction < or = 30% and to follow them up for 3 to 4.5 years. Nearly 30 French centres will participate in this trial. After an initial, open period of evaluation of tolerance (5 mg to 15 mg/day of lisinopril in France), the patients will be randomised to two groups. After randomisation, all patients will receive 5 mg per day of lisinopril. The "high dose" group will receive 20 mg/day for two weeks, then 30 mg/day in addition to the "open dosage". In cases of intolerance, the dosage may be reduced to 20 mg/day or 10 mg/day, or the drug may be withdrawn.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Service de cardiologie, CHU Pitié-Salpêtrière, Paris.
authors.forename: M
authors.initials: M
authors.lastname: Komajda
authors.forename: M C
authors.initials: MC
authors.lastname: Wimart
authors.forename: E
authors.initials: E
authors.lastname: Thibout
mesh_terms: D002985:Clinical Protocols; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D017706:Lisinopril / Q000627:therapeutic use*; D016019:Survival Analysis
chemical_list: D017706:Lisinopril
vernacular_title: L'étude ATLAS (assessment of treatment with lisinopril and survival); justification et objectifs.