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Effects of enalapril on congestive heart failure and survival until 12 months have been evaluated in 60 patients with congestive heart failure (II, III, IV NYHA class) versus 60 control patients. Enalapril has been administered with digitalis and diuretic for 12 months 5 mg twice a day; in 60 control patients only digitalis and diuretic have been administered. Patients have been controlled every month during 12 months evaluating: NYHA class, time of exercise at treadmill, ejection time of left ventricle, speed index of ejection, cardiac output, systolic output, ECG, blood pressure, creatinine, BUN and electrolytes. After 12 months a significant increase (p less than 0.001) of systolic and cardiac output in patients with enalapril has been recorded. Also the increase of exercise time was more evident in patients with enalapril (p less than 0.01). The results show that long term treatment with enalapril in patients with congestive heart failure, improving cardiac performance, gives an hemodynamic and symptomatic benefit.