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Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure

National Heart, Lung, and Blood Institute (NHLBI)
July 31, 1991


Background: Patients with congestive heart failure have a high mortality rate and are also frequently hospitalized. We studied the effect of the angiotensin converting enzyme inhibitor, enalapril on mortality and hospitalizations in heart failure patients with ejection fraction <=0.35. Methods: Patients receiving conventional treatment for heart failure were randomized to receive either placebo (n=1284) or enalapril (n=1285) at doses of 2.5 to 20 mg per day in a double blind trial. Approximately 90 percent were in New York Heart Association functional classes II and III. Follow up averaged 41.4 months. Results: There were 510 deaths in the control group (39.7 percent) compared with 452 deaths in the enalapril group (35.2 percent) (16 percent risk reduction, 95 percent confidence interval of 5 percent to 26 percent, P=0.0036). Although reductions in mortality were observed in several categories of cardiac deaths, the largest reduction occurred among deaths attributed to progressive heart failure (251 placebo vs 209 enalapril; risk reduction of 22 percent, confidence interval of 6 percent to 35 percent). There was little apparent effect on deaths classified as being due to arrhythmia without pump failure. Fewer patients died or were hospitalized for worsening heart failure (736 placebo vs 613 enalapril; risk reduction of 26 percent, confidence intervals of 18 percent to 34 percent p<0.0001). Conclusions: The addition of an angiotensin converting enzyme inhibitor, enalapril, to conventional therapy, significantly reduced mortality and hospitalizations for heart failure in patients with congestive heart failure and reduced ejection fraction. The full article describing the final results appears in the N Engl J Med 1991 Aug 1;325(5):293-302.

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None available online. Please refer to N Engl J Med 1991 Aug 1;325(5):293-302.