Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure

Congestive heart failure affects almost two million people annually; 15 to 50 percent of these patients die within one year, depending on their severity of illness. A number of drugs have been investigated for use in treating this disease. Angiotensin-converting-enzyme inhibitors, which block enzymes that are involved in the production of angiotensin, have shown promise in the treatment of congestive heart failure. (Angiotensin causes vasoconstriction, or narrowing of blood vessels.) It is thought that angiotensin-converting-enzyme inhibitors may relieve some of the symptoms of congestive heart failure and reduce the number of hospitalizations and deaths resulting from it. This study examined the effectiveness of enalapril, an angiotensin-converting-enzyme inhibitor, in treating this disease and reducing mortality. A total of 2,569 patients with congestive heart failure and decreased left ventricular ejection fraction (diminished percentage of blood pumped from the heart at the end of each heartbeat) were assessed; 1,285 patients received enalapril at various dosages, and 1,284 were given a placebo. Hospitalizations, deaths, and side effects of the drug were monitored for up to 55 months. After 48 months, 510 patients in the placebo group had died; 461 deaths were attributed to cardiovascular causes. During the same period, there were 452 deaths in the enalapril group, of which 399 were due to cardiovascular problems. The greatest reduction in mortality in the enalapril-treated patients occurred during in the first 24 months of therapy. Hospitalizations for heart failure were required for 736 patients in the placebo group and 613 patients who were given enalapril. Enalapril had the greatest effect in reducing hospitalization during the first year of treatment. Subgroups of patients were also assessed to determine in which patients enalapril had the most favorable effects. Results showed that enalapril was equally effective among the subgroups. Only minor side effects, including dizziness and cough, were associated with the drug. These results indicate that enalapril can significantly reduce mortality and the need for hospitalization in patients suffering from congestive heart failure. (Consumer Summary produced by Reliance Medical Information, Inc.)