Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions
- PMID: 1463530
- DOI: 10.1056/NEJM199209033271003
Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions
Erratum in
- N Engl J Med 1992 Dec 10;327(24):1768
Abstract
Background: It is not known whether the treatment of patients with asymptomatic left ventricular dysfunction reduces mortality and morbidity. We studied the effect of an angiotensin-converting--enzyme inhibitor, enalapril, on total mortality and mortality from cardiovascular causes, the development of heart failure, and hospitalization for heart failure among patients with ejection fractions of 0.35 or less who were not receiving drug treatment for heart failure.
Methods: Patients were randomly assigned to receive either placebo (n = 2117) or enalapril (n = 2111) at doses of 2.5 to 20 mg per day in a double-blind trial. Follow-up averaged 37.4 months.
Results: There were 334 deaths in the placebo group, as compared with 313 in the enalapril group (reduction in risk, 8 percent by the log-rank test; 95 percent confidence interval, -8 percent [an increase of 8 percent] to 21 percent; P = 0.30). The reduction in mortality from cardiovascular causes was larger but was not statistically significant (298 deaths in the placebo group vs. 265 in the enalapril group; risk reduction, 12 percent; 95 percent confidence interval, -3 to 26 percent; P = 0.12). When we combined patients in whom heart failure developed and those who died, the total number of deaths and cases of heart failure was lower in the enalapril group than in the placebo group (630 vs. 818; risk reduction, 29 percent; 95 percent confidence interval, 21 to 36 percent; P less than 0.001). In addition, fewer patients given enalapril died or were hospitalized for heart failure (434 in the enalapril group; vs. 518 in the placebo group; risk reduction, 20 percent; 95 percent confidence interval, 9 to 30 percent; P less than 0.001).
Conclusions: The angiotensin-converting--enzyme inhibitor enalapril significantly reduced the incidence of heart failure and the rate of related hospitalizations, as compared with the rates in the group given placebo, among patients with asymptomatic left ventricular dysfunction. There was also a trend toward fewer deaths due to cardiovascular causes among the patients who received enalapril.
Comment in
-
The prevention of heart failure--a new agenda.N Engl J Med. 1992 Sep 3;327(10):725-7. doi: 10.1056/NEJM199209033271010. N Engl J Med. 1992. PMID: 1495526 Clinical Trial. No abstract available.
Similar articles
-
Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.N Engl J Med. 1991 Aug 1;325(5):293-302. doi: 10.1056/NEJM199108013250501. N Engl J Med. 1991. PMID: 2057034 Clinical Trial.
-
The effect of digoxin on mortality and morbidity in patients with heart failure.N Engl J Med. 1997 Feb 20;336(8):525-33. doi: 10.1056/NEJM199702203360801. N Engl J Med. 1997. PMID: 9036306 Clinical Trial.
-
Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II).N Engl J Med. 1992 Sep 3;327(10):678-84. doi: 10.1056/NEJM199209033271002. N Engl J Med. 1992. PMID: 1495520 Clinical Trial.
-
Role of converting enzyme inhibitors in the treatment of heart failure.J Am Coll Cardiol. 1993 Oct;22(4 Suppl A):154A-157A. doi: 10.1016/0735-1097(93)90481-f. J Am Coll Cardiol. 1993. PMID: 8376687 Review.
-
Selections from current literature: treatment of congestive heart failure with angiotensin converting enzyme inhibitors.Fam Pract. 1992 Sep;9(3):362-6. doi: 10.1093/fampra/9.3.362. Fam Pract. 1992. PMID: 1459396 Review. No abstract available.
Cited by
-
Medical Management and Device-Based Therapies in Chronic Heart Failure.J Soc Cardiovasc Angiogr Interv. 2023 Dec 4;2(6Part B):101206. doi: 10.1016/j.jscai.2023.101206. eCollection 2023 Nov-Dec. J Soc Cardiovasc Angiogr Interv. 2023. PMID: 39131076 Free PMC article. Review.
-
Insight from International Guidelines: do We Have Satisfactory Recommendations for Secondary Mitral Regurgitation?Rev Cardiovasc Med. 2022 May 17;23(5):180. doi: 10.31083/j.rcm2305180. eCollection 2022 May. Rev Cardiovasc Med. 2022. PMID: 39077618 Free PMC article. Review.
-
An Updated Review of the Management of Chronic Heart Failure in Patients with Chronic Kidney Disease.Rev Cardiovasc Med. 2024 Apr 11;25(4):144. doi: 10.31083/j.rcm2504144. eCollection 2024 Apr. Rev Cardiovasc Med. 2024. PMID: 39076544 Free PMC article. Review.
-
Revisiting Race and the Benefit of RAS Blockade in Heart Failure: A Meta-Analysis of Randomized Clinical Trials.JAMA. 2024 Jun 25;331(24):2094-2104. doi: 10.1001/jama.2024.6774. JAMA. 2024. PMID: 38809561
-
Is Sacubitril/Valsartan a Superior Agent in Heart Failure With Reduced Ejection Fraction? A Review of Randomized Comparative Trials.Hosp Pharm. 2024 Jun;59(3):282-287. doi: 10.1177/00185787231212619. Epub 2023 Dec 6. Hosp Pharm. 2024. PMID: 38764991 Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical