TitleEFFECT OF ENALAPRIL ON MORTALITY AND THE DEVELOPMENT OF HEART-FAILURE IN ASYMPTOMATIC PATIENTS WITH REDUCED LEFT-VENTRICULAR EJECTION FRACTIONS
Publication TypeJournal Article
Year of Publication1992
AuthorsNicklas, JM, Pitt, B, Timmis, G, Breneman, G, Jafri, SM, Duvernoy, WFC, Davis, SW, Goldberg, MJ, Blair, J, Mancini, GBJ, Johnson, T, Luckoff, C, Henry, G, Wlodkowski, MB, Czajka, M, Reinstein, D, Richards, J, Lewis, R, Davey, DE, Mallotte, K, Moll, A, Quain, L, Thomasma, P, Schreiber, S, Ursiny, E, Rogers, WJ, Arciniegas, JG, Bittner, V, Bulle, TM, Cavender, JB, Charles, ED, Dellitalia, LJ, Henzlova, MJ, Maclean, WA, Papapietro, SE, Paine, TD, Salvia, MF, Sheffield, LT, Stanley, AWH, Vantassel, E, Taylor, HA, Carlisle, K, Baker, A, Blackburn, G, Bonville, B, Bynum, K, Deriso, S, Kerns, D, Lambert, N, Merritt, L, Nance, V, Reddy, E, Atkins, F, Cox, M, Pouleur, H, Rousseau, MF, Melin, J, Marchandise, B, Schroeder, E, Ahn, S, McIntyre, KM, Tow, D, Pietro, D, Gillie, E, Sharma, G, Woods, P, Dondero, MEC, Brown, R, Strauss, W, Loscalzo, J, Salem, D, Konstam, MA, Udelson, JE, Weinshel, A, Gaasch, W, Dolan, N, Hoshino, R, Lane, C, Kelly, S, Kilcoyne, L, Kinan, D, Metherall, J, Paradise, L, Toltsis, H, Lejemtel, TH, Frishman, WH, Wexler, J, Galvao, M, Mills, LA, Jones, M, Kohn, RM, Morey, PD, Forte, KE, Hong, MJ, Maddi, JL, Zizzi, JA, Bernaski, EJ, Roberts, NA, Bonora, MM, Celano, JA, Jo, YS
JournalNew England Journal of Medicine
Volume327
Pagination685-691
Type of ArticleJournal Article
ISSN0028-4793
Abstract

Background. It is not known whether the treatment of patients with asymptomatic left ventricular dysfunction reduces mortality and morbidity. We studied the effect of an angiotensin-converting-enzyme inhibitor, enalapril, on total mortality and mortality from cardiovascular causes, the development of heart failure, and hospitalization for heart failure among patients with ejection fractions of 0.35 or less who were not receiving drug treatment for heart failure. Methods. Patients were randomly assigned to receive either placebo (n = 2117) or enalapril (n = 2111) at doses of 2.5 to 20 mg per day in a double-blind trial. Follow-up averaged 37.4 months. Results. There were 334 deaths in the placebo group, as compared with 313 in the enalapril group (reduction in risk, 8 percent by the log-rank test; 95 percent confidence interval, -8 percent [an increase of 8 percent] to 21 percent; P = 0.30). The reduction in mortality from cardiovascular causes was larger but was not statistically significant (298 deaths in the placebo group vs. 265 in the enalapril group; risk reduction, 12 percent; 95 percent confidence interval, -3 to 26 percent; P = 0.12). When we combined patients in whom heart failure developed and those who died, the total number of deaths and cases of heart failure was lower in the enalapril group than in the placebo group (630 vs. 818; risk reduction, 29 percent; 95 percent confidence interval, 21 to 36 percent; P

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