TY  - BOOK
AU  - Dooley, Daniel J
AU  - Lam, Phillip H
TI  - Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial
SN  - 1388-9842
PY  - 2018///
KW  - *Enalapril/ad [Administration & Dosage]
KW  - *Heart Failure/dt [Drug Therapy]
KW  - *Stroke Volume/de [Drug Effects]
KW  - Angiotensin-Converting Enzyme Inhibitors/ad [Administration & Dosage]
KW  - Canada/ep [Epidemiology]
KW  - Cause of Death/td [Trends]
KW  - Dose-Response Relationship, Drug
KW  - Double-Blind Method
KW  - Europe/ep [Epidemiology]
KW  - Follow-Up Studies
KW  - Heart Failure/mo [Mortality]
KW  - Heart Failure/pp [Physiopathology]
KW  - Humans
KW  - Stroke Volume/ph [Physiology]
KW  - Survival Rate/td [Trends]
KW  - Treatment Outcome
KW  - United States/ep [Epidemiology]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N2  - AIMS: To examine associations of below-target and target dose of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, with outcomes in patients with heart failure and reduced ejection fraction (HFrEF) in the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial; CONCLUSION: In patients with HFrEF, the clinical benefits of ACE inhibitors appear to be similar at both below-target and target doses. Copyright (c) 2017 The Authors. European Journal of Heart Failure (c) 2017 European Society of Cardiology; METHODS AND RESULTS: Two thousand five hundred and sixty-nine patients with HFrEF (ejection fraction <=35%) were randomized to below-target (5-10 mg/day) dose placebo (n = 1284) or enalapril (n = 1285). One month post-randomization, blind up-titration to target (20 mg/day) dose was attempted for both study drugs in 2458 patients. Among the 1444 patients who achieved dose up-titration (placebo, n=748; enalapril, n=696; mean dose for both groups, 20.0 mg/day), target dose enalapril (vs. target dose placebo) was associated with a 9% absolute lower risk of the combined endpoint of heart failure hospitalization or all-cause mortality [adjusted hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.60-0.81; P < 0.001] during 4 years of follow-up. Among the 1014 patients who could not achieve target dose (placebo, n=486; enalapril, n=528; mean dose for both groups, 8.8 mg/day), below-target dose enalapril (vs. below-target dose placebo) was associated with a 12% absolute lower risk of the combined endpoint of heart failure hospitalization or all-cause mortality (adjusted HR 0.68; 95% CI 0.57-0.81; P < 0.001). Among the 1224 patients receiving enalapril, target (vs. below-target) dose had no association with the combined endpoint of heart failure hospitalization or all-cause mortality (adjusted HR 1.04; 95% CI 0.87-1.23; P = 0.695)
UR  - https://dx.doi.org/10.1002/ejhf.937
ER  -