Effects of enalapril and neuroendocrine activation on prognosis in severe congestive heart failure: follow-up of the CONSENSUS trial

Congestive heart failure (CHF) is a condition in which the heart is unable to pump sufficient blood to supply oxygen and nutrients to the body. One way that the body seeks to compensate for the insufficient blood supply is by mobilizing neurohormonal responses that tend to increase blood pressure; this compensatory neurohormonal activation is actually detrimental to cardiovascular function and results in increased mortality. Drugs that block one of these neurohormonal steps (angiotensin-converting enzyme inhibition therapy in the treatment of /ACE~ inhibitors, which inhibit the production of the potent vasoconstrictor angiotensin II) are widely used as treatment for CHF. A large-scale study was carried out and has been reported on previously (the CONSENSUS Trial) in which 253 patients were randomly assigned to receive either their normal course of treatment for CHF (placebo group) or their normal course of treatment plus enalapril, an ACE inhibitor. At the end of the six-month treatment period, significantly more of the enalapril patients than placebo patients were alive. This same pattern was evident at six-month and two-year follow-ups. In the placebo group, there were significant correlations between mortality and blood levels of norepinephrine, epinephrine, angiotensin II, aldosterone, and atrial natriuretic peptide. No such relationships were seen in the group treated with enalapril. These data suggest that enalapril may act at least partially through counteracting neuroendocrine activation, particularly through activation of the renin-angiotensin system. (Consumer Summary produced by Reliance Medical Information, Inc.)