A Comparison of Enalapril with Hydralazine–Isosorbide Dinitrate in the Treatment of Chronic Congestive Heart Failure

Cohn, Jay N.; Johnson, Gary R.; Ziesche, Susan; Cobb, Frederick R.; Francis, Gary S.; Tristani, Felix E.; Smith, Raymond A.; Dunkman, W. Bruce; Loeb, Henry S.; Wong, Maylene; Bhat, Geetha; Goldman, Steven; Fletcher, Ross D.; Doherty, James E.; Hughes, C. V.; Carson, Peter E.; Cintrón, Guillermo; Shabetai, Ralph; Haakenson, Clair

doi:10.1056/nejm199108013250502

Cited by 2,568 publications

(920 citation statements)

References 18 publications

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“…By contrast, the prescription of ACE inhibitors has increased (9% in 1992) [1]. However, only around a quarter of all heart failure patients in Sweden are prescribed this latter treatment, despite the fact that these are the most effective preparations against mortality and morbidity [29,30]. A British research team analysing the use of ACE inhibitors also reached the same conclusion [31].…”

Section: Continued Low Share Of Ace Inhibitor Prescriptionsmentioning

confidence: 99%

The health care costs of heart failure in Sweden

Rydén‐Bergsten

Andersson

1999

Journal of Internal Medicine

139

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Abstract. Ryde Ân-Bergsten T, Andersson F (AstraZeneca R&D, Lund; and AstraZeneca R&D, Mo Èlndal; Sweden). The health care costs of heart failure in Sweden. J Intern Med 1999; 246: 275±284.Aim. Heart failure is a common and serious condition requiring extensive health care resources. The aim of this study is to estimate the total treatment costs of heart failure in Sweden.Methods and results. The study is a prevalencebased cost-of-illness study. It includes costs of institutional care (hospitals and nursing homes), outpatient care, surgery and drugs. The costs are estimated based on official Swedish statistics, and on various clinical and epidemiological studies. The results are expressed in 1996 prices. The total annual treatment costs for heart failure are approximately Swedish kronor (SEK) 2000±2600 million, or nearly 2% of the Swedish health care budget. Institutional care is the single largest component, amounting to SEK 1300±1900 million, or about 65±75% of the costs of heart failure treatment. Conclusions. The results from this study indicate that heart failure is a costly condition. Efforts to develop effective management programmes that can reduce the need for expensive institutional care, without a negative impact on quality of life, morbidity and mortality, should be given high priority.

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Section: Continued Low Share Of Ace Inhibitor Prescriptionsmentioning

confidence: 99%

The health care costs of heart failure in Sweden

Rydén‐Bergsten

Andersson

1999

Journal of Internal Medicine

139

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“…The vasodilatory effect alone does not explain the positive effects of ACE inhibitors, because they are superior in influencing the survival in patients with congestive heart failure to vasodilatory treatment with the combinations of nitrates and hydralazine [17]. ACE inhibitors also decrease preload and lead to a decrease of cardiac dilatation.…”

Section: Discussionmentioning

confidence: 99%

Czech and Slovak spirapril intervention study (CASSIS)

Widimský

Kremer

Jerie

et al. 1995

Eur J Clin Pharmacol

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“…The V‐HeFT I trial compared hydralazine and ISDN versus prazosin with placebo in 642 men with impaired systolic function and demonstrated a 34% relative risk reduction at 2 years ( P < 0.028) (Cohn et al ., 1986). V‐HeFT II was undertaken in 1991 to compare this combination with and without enalapril, with significant mortality benefit seen in the enalapril arm (Cohn et al ., 1991). Hydralazine and ISDN in combination was also shown to reduce nitrate tolerance by previously unknown mechanisms.…”

Section: Evidence‐based Pharmacological Agentsmentioning

confidence: 99%

Present and future pharmacotherapeutic agents in heart failure: an evolving paradigm

Loudon

Noordali

Gollop

et al. 2016

British J Pharmacology

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Many conditions culminate in heart failure (HF), a multi‐organ systemic syndrome with an intrinsically poor prognosis. Pharmacotherapeutic agents that correct neurohormonal dysregulation and haemodynamic instability have occupied the forefront of developments within the treatment of HF in the past. Indeed, multiple trials aimed to validate these agents in the 1980s and early 1990s, resulting in a large and robust evidence‐base supporting their use clinically. An established treatment paradigm now exists for the treatment of HF with reduced ejection fraction (HFrEF), but there have been very few notable developments in recent years. HF remains a significant health concern with an increasing incidence as the population ages. We may indeed be entering the surgical era for HF treatment, but these therapies remain expensive and inaccessible to many. Newer pharmacotherapeutic agents are slowly emerging, many targeting alternative therapeutic pathways, but with mixed results. Metabolic modulation and manipulation of the nitrate/nitrite/nitric oxide pathway have shown promise and could provide the answers to fill the therapeutic gap between medical interventions and surgery, but further definitive trials are warranted. We review the significant evidence base behind the current medical treatments for HFrEF, the physiology of metabolic impairment in HF, and discuss two promising novel agents, perhexiline and nitrite.

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A Comparison of Enalapril with Hydralazine–Isosorbide Dinitrate in the Treatment of Chronic Congestive Heart Failure

Cited by 2,568 publications

References 18 publications

The health care costs of heart failure in Sweden

The health care costs of heart failure in Sweden

Czech and Slovak spirapril intervention study (CASSIS)

Present and future pharmacotherapeutic agents in heart failure: an evolving paradigm

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