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Low-dose enalapril in severe chronic heart failure

  • Congestive Heart Failure
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Summary

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<0.001), and the scintigraphically determined ejection fraction of the left ventricle increased from 33±18% to 40±19% (p<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<0.001), and plasma aldosterone decreased from 47.7±7.6 ng/dl to 19.9±4.8 ng/dl (p<0.01). In group C no significant change occurred. Comparing the actual changes (deltas) of the NYHA functional class (p<0.02), end-diastolic diameter and ejection fraction of the left ventricle, plasma-renin activity, and plasma aldosterone (p<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.

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Authors and Affiliations

  1. Med. Clinic III, University of Tübingen, Federal Republic of Germany

    Bernhard Krämer, Hans M. Hoffmeister, Teut Risler & Ludger Seipel

  2. Department of Nuclear Medicine, University of Tübingen, Federal Republic of Germany

    Wolfgang Müller-Schauenburg

  3. Michael Reese Hospital and Medical Center, Cardiovascular Institute, The University of Chicago, Lake Shore Drive at 31st Street, 60616, Chicago, IL, USA

    Christian G. Brilla MD

Authors
  1. Christian G. Brilla MD
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  2. Bernhard Krämer
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  3. Hans M. Hoffmeister
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  4. Wolfgang Müller-Schauenburg
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  5. Teut Risler
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  6. Ludger Seipel
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Brilla, C.G., Krämer, B., Hoffmeister, H.M. et al. Low-dose enalapril in severe chronic heart failure. Cardiovasc Drug Ther 3, 211–218 (1989). https://doi.org/10.1007/BF01883867

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