Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial.
Citation: European Journal of Heart Failure. 20(2):359-369, 2018 02.PMID: 28980368Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Enalapril/ad [Administration & Dosage] | *Heart Failure/dt [Drug Therapy] | *Stroke Volume/de [Drug Effects] | Angiotensin-Converting Enzyme Inhibitors/ad [Administration & Dosage] | Canada/ep [Epidemiology] | Cause of Death/td [Trends] | Dose-Response Relationship, Drug | Double-Blind Method | Europe/ep [Epidemiology] | Follow-Up Studies | Heart Failure/mo [Mortality] | Heart Failure/pp [Physiopathology] | Humans | Stroke Volume/ph [Physiology] | Survival Rate/td [Trends] | Treatment Outcome | United States/ep [Epidemiology]Year: 2018ISSN:- 1388-9842
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 28980368 | Available | 28980368 |
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).
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