Comparison of low versushigh dose enalapril therapy for patients with severe congestive heart failure (CHF)

Vagelos, Randall H.; Nejedly, Mary; Willson, K. C.; Yee, Yin‐Gail; Fowler, Michael J.

doi:10.1016/0735-1097(91)92065-t

Cited by 12 publications

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“…Because the study was designed as a long-term examination of the effects of treatment on mortality and disease progression, the investigators recruited patients who were in a stable clinical condition and able to tolerate long-term treatment. Before randomization, all patients were initially given 2.5 mg of enalapril twice daily for 2-7 days to identify those unable to comply with the regimen or to tolerate active drug.6 After this initial phase, patients were given matching placebo for [14][15][16][17] days to allow identification and exclusion of those whose clinical condition worsened on withdrawal of the drug. Following randomization, patients received double-blind treatment with either placebo (n = 1284) or enalapril (n = 1285).…”

Section: Solvdmentioning

confidence: 99%

An overview of survival studies in patients with heart failure

Oldershaw

1992

Postgraduate Medical Journal

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Section: Solvdmentioning

confidence: 99%

An overview of survival studies in patients with heart failure

Oldershaw

1992

Postgraduate Medical Journal

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New evidence for improved survival in chronic heart failure

Clark

Coats

1994

Clinical Cardiology

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Summary:Chronic heart failure is a common clinical syndrome with high associated mortality and morbidity. Recent advances in therapy for the condition with vasodilators and, in particular, angiotensin-converting enzyme inhibitors, have led to hopes for improvement in survival. Several large scale studies examining the role of vasodilators have reported over the la3t few years, and the role of vasodilators in the treatment and prevention of chronic heart failure is being delineated. There is new hope for patients with symptomatic heart failure; symptoms can be alleviated and prognosis improved. Increasingly, it appears as if there is a role for drug therapy in preventing the onset of chronic heart failure. In this paper, we examine the results of these studies and of some smaller studies in order to discuss the implications for current therapy and future research.derlying pathophysiologic mechanisms of chronic heart failure are not completely understood, but treatment has become available which improves the prognostic outlook. This paper reviews the recent large trials examining the role of vasodilation in the treatment of heart failure.Chronic heart failure is characterized by the activation of a number of neurohumoral mechanisms in response to reduced renal perfusion, notably the sympathetic5 and renin-angiotensin6.7 systems. At least partially in consequence of this, the peripheral vascular resistance is greatly elevated in chronic heart failure.8 Consequently, in recent years, a number of independent clinical trials has been conducted in order to assess the value of various vasodilating drugs in thls condition. The results of these studies demonstrate that the prognosis of even very Severe heart failure can be greatly improved, carrying considerable implications for patient management.

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Pharmacologic, Pharmacokinetic, and Therapeutic Differences among ACE Inhibitors

White

1998

Pharmacotherapy

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Angiotensin‐converting enzyme (ACE) inhibitors are a heterogeneous group of agents, and important pharmacologic, pharmacokinetic, and therapeutic differences among them must be understood to obtain optimal therapy. For patients with severe liver disease, lisinopril and captopril are not prodrugs (e.g., do not require hepatic activation), and lisinopril has almost solely renal elimination. Enalaprilat, the intravenous formulation of enalapril, is the only intravenously available ACE inhibitor and can be given to patients with severe liver dysfunction as it is also not a prodrug. Fosinopril is the only drug with compensatory dual routes of elimination, and it does not require dosage adjustment in patients with reduced renal function, as other ACE inhibitors do. Captopril and moexipril have potential drug‐food interactions and are the only agents that should be spaced from meals. The ACE inhibitors also differ in their dialyzability, half‐life, lipophilicity, trough:peak ratios, approved indications, and therapeutic information available for many indications.

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Comparison of low versushigh dose enalapril therapy for patients with severe congestive heart failure (CHF)

Cited by 12 publications

References 0 publications

An overview of survival studies in patients with heart failure

An overview of survival studies in patients with heart failure

New evidence for improved survival in chronic heart failure

Pharmacologic, Pharmacokinetic, and Therapeutic Differences among ACE Inhibitors

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