Citation: European Journal of Heart Failure. 20(2):359-369, 2018 02..Journal: European journal of heart failure.Published: ; 2018ISSN: 1388-9842.Full author list: Lam PH; Dooley DJ; Fonarow GC; Butler J; Bhatt DL; Filippatos GS; Deedwania P; Forman DE; White M; Fletcher RD; Arundel C; Blackman MR; Adamopoulos C; Kanonidis IE; Aban IB; Patel K; Aronow WS; Allman RM; Anker SD; Pitt B; Ahmed A.UI/PMID: 28980368.Subject(s): Angiotensin-Converting Enzyme Inhibitors/ad [Administration & Dosage] | Canada/ep [Epidemiology] | Cause of Death/td [Trends] | Dose-Response Relationship, Drug | Double-Blind Method | *Enalapril/ad [Administration & Dosage] | Europe/ep [Epidemiology] | Follow-Up Studies | *Heart Failure/dt [Drug Therapy] | Heart Failure/mo [Mortality] | Heart Failure/pp [Physiopathology] | Humans | *Stroke Volume/de [Drug Effects] | Stroke Volume/ph [Physiology] | Survival Rate/td [Trends] | Treatment Outcome | United States/ep [Epidemiology]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1002/ejhf.937 (Click here)Abbreviated citation: Eur J Heart Fail. 20(2):359-369, 2018 02.Abstract: 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.Abstract: 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).Abstract: 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.