Results of the veterinary enalapril trial to prove reduction in onset of heart failure in dogs chronically treated with enalapril alone for compensated, naturally occurring mitral valve insufficiency.
OBJECTIVE
To determine the efficacy of long-term enalapril administration in delaying the onset of congestive heart failure (CHF).


METHODS
Placebo-controlled, double-blind, multicenter, randomized trial.


METHODS
124 dogs with compensated mitral valve regurgitation (MR).


METHODS
Dogs randomly assigned to receive enalapril or placebo were monitored for the primary endpoint of onset of CHF for < or = 58 months. Secondary endpoints included time from study entry to the combined endpoint of CHF-all-cause death; number of dogs free of CHF at 500, 1,000, and 1,500 days; and mean number of CHF-free days.


RESULTS
Kaplan-Meier estimates of the effect of enalapril on the primary endpoint did not reveal a significant treatment benefit. Chronic enalapril administration did have a significant benefit on the combined endpoint of CHF-all-cause death (benefit was 317 days [10.6 months]). Dogs receiving enalapril remained free of CHF for a significantly longer time than those receiving placebo and were significantly more likely to be free of CHF at day 500 and at study end.


CONCLUSIONS
Chronic enalapril treatment of dogs with naturally occurring, moderate to severe MR significantly delayed onset of CHF, compared with placebo, on the basis of number of CHF-free days, number of dogs free of CHF at days 500 and study end, and increased time to a combined secondary endpoint of CHF-all-cause death. Improvement in the primary endpoint, CHF-free survival, was not significant. Results suggest that enalapril modestly delays the onset of CHF in dogs with moderate to severe MR.
Atkins
Clarke E
CE
Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA.
Keene
Bruce W
BW
Brown
William A
WA
Coats
Julie R
JR
Crawford
Mary Ann
MA
DeFrancesco
Teresa C
TC
Edwards
N Joel
NJ
Fox
Phillip R
PR
Lehmkuhl
Linda B
LB
Luethy
Michael W
MW
Meurs
Kathryn M
KM
Petrie
Jean-Paul
JP
Pipers
Frank S
FS
Rosenthal
Steven L
SL
Sidley
Jennifer A
JA
Straus
Justin H
JH
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000662:veterinary; D018450:Disease Progression; D018572:Disease-Free Survival; D004283:Dog Diseases / Q000401:mortality / Q000517:prevention & control*; D004285:Dogs; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000517:prevention & control / Q000662:veterinary*; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000662:veterinary*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004656:Enalapril