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Early Effects of Starting Doses of Enalapril in Patients with Chronic Heart Failure in the SOLVD Treatment Trial.

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Citation: American Journal of Medicine. 133(2):e25-e31, 2020 02.PMID: 31401165Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Enalapril/ad [Administration & Dosage] | *Enalapril/tu [Therapeutic Use] | *Heart Failure/dt [Drug Therapy] | Aged | Chronic Disease/dt [Drug Therapy] | Dose-Response Relationship, Drug | Female | Humans | Male | Middle AgedYear: 2020 ISSN:

0002-9343

Name of journal: The American journal of medicineAbstract: BACKGROUND: In the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial, similar clinical benefits were observed between starting doses of enalapril and the target dose achieved by post-randomization up-titration. In our current analysis, protecting the randomization, we examined the early effects of starting doses of enalapril.CONCLUSION: These data suggest that in stable ambulatory patients with heart failure with reduced ejection fraction, the magnitude of the early effect of starting doses of enalapril is similar to that observed during longer-term therapy with the target doses of the drug.Copyright (c) 2019. Published by Elsevier Inc.METHODS: 2569 patients with mild-to-moderate chronic heart failure with reduced ejection fraction (HFrEF; ejection fraction <=35%) were randomized to receive starting doses (5-10mg/day) of placebo (n=1284) or enalapril (n=1285). At day 14, both study drugs were blindly up-titrated to the target dose (20mg/day). Overall, 89% (2284/2569) of the patients returned for dose up-titration, which was achieved in 56% (1444/2248), 48% (696/1444) of whom were in the enalapril group. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes in the enalapril group were estimated.RESULTS: HRs (95% CIs) for all-cause mortality, heart failure hospitalization, and the combined endpoint of heart failure hospitalization or all-cause mortality at 14days after randomization were 0.80 (0.32-2.03), 0.63 (0.35-1.12), and 0.65 (0.39-1.06) 0.82, respectively. Corresponding HRs (95% CIs) at 30days were (0.41-1.67), 0.43 (0.27-0.68), and 0.43 (0.27-0.68). The magnitude of these early effects of starting doses of enalapril is similar to its previously reported long-term effects at the target dose.All authors: Ahmed A, Allman RM, Faselis C, Fonarow GC, Lam PH, Morgan CJ, Packer M, Pitt B, Singh SOriginally published: American Journal of Medicine. 2019 Aug 08Fiscal year: FY2020Digital Object Identifier:

https://dx.doi.org/10.1016/j.amjmed.2019.06.053

Date added to catalog: 2019-08-27

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	31401165	Available		31401165

BACKGROUND: In the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial, similar clinical benefits were observed between starting doses of enalapril and the target dose achieved by post-randomization up-titration. In our current analysis, protecting the randomization, we examined the early effects of starting doses of enalapril.

CONCLUSION: These data suggest that in stable ambulatory patients with heart failure with reduced ejection fraction, the magnitude of the early effect of starting doses of enalapril is similar to that observed during longer-term therapy with the target doses of the drug.

METHODS: 2569 patients with mild-to-moderate chronic heart failure with reduced ejection fraction (HFrEF; ejection fraction <=35%) were randomized to receive starting doses (5-10mg/day) of placebo (n=1284) or enalapril (n=1285). At day 14, both study drugs were blindly up-titrated to the target dose (20mg/day). Overall, 89% (2284/2569) of the patients returned for dose up-titration, which was achieved in 56% (1444/2248), 48% (696/1444) of whom were in the enalapril group. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes in the enalapril group were estimated.

RESULTS: HRs (95% CIs) for all-cause mortality, heart failure hospitalization, and the combined endpoint of heart failure hospitalization or all-cause mortality at 14days after randomization were 0.80 (0.32-2.03), 0.63 (0.35-1.12), and 0.65 (0.39-1.06) 0.82, respectively. Corresponding HRs (95% CIs) at 30days were (0.41-1.67), 0.43 (0.27-0.68), and 0.43 (0.27-0.68). The magnitude of these early effects of starting doses of enalapril is similar to its previously reported long-term effects at the target dose.

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