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Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial
- Source :
- European Journal of Heart Failure. 20:359-369
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
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. 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). Conclusion In patients with HFrEF, the clinical benefits of ACE inhibitors appear to be similar at both below-target and target doses.
- Subjects :
- medicine.medical_specialty
Ejection fraction
business.industry
Hazard ratio
030204 cardiovascular system & hematology
Lower risk
Placebo
medicine.disease
Confidence interval
03 medical and health sciences
0302 clinical medicine
Internal medicine
Heart failure
medicine
Cardiology
030212 general & internal medicine
Enalapril
Cardiology and Cardiovascular Medicine
Intensive care medicine
business
Survival rate
medicine.drug
Subjects
Details
- ISSN :
- 13889842
- Volume :
- 20
- Database :
- OpenAIRE
- Journal :
- European Journal of Heart Failure
- Accession number :
- edsair.doi...........798a29eff07888ca46f572126a6e7715