A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure

Article Abstract:

Chronic heart failure affects about two million people, and reduces both the quality and length of life. It is characterized by abnormal function of the left ventricle, and results in diminished pumping action of the heart. Recent studies have indicated that vasodilators, drugs that dilate or widen blood vessels, may reduce mortality and improve heart functioning in patients with this disease. Hydralazine-isosorbide dinitrate, a vasodilator, has been shown to be effective in treating mild-to-moderate congestive heart failure. Enalapril, a relatively new vasodilator, has been reported to be relieve the symptoms of severe congestive heart failure. However, its effect in treating mild-to-moderate cases is unknown. To determine which drug is more effective in reducing mortality and treating chronic congestive heart failure, 804 male patients with mild-to-moderate congestive heart failure received either enalapril (403 patients) or hydralazine-isosorbide dinitrate (401 patients). During follow-up, which ranged from 6 months to 5.7 years, 285 patients died; 132 from the enalapril group and 153 from the hydralazine-isosorbide dinitrate group. After two years of therapy, mortality was significantly lower in the enalapril group due largely to the decreased incidence of sudden death among these patients. Blood pressure was significantly lower for the first 13 weeks and heart rate was significantly lower for the first year in the enalapril group. Ejection fractions (the percentage of blood pumped from the left ventricle at the end of a heartbeat) were significantly increased with both drugs, but were significantly greater in the hydralazine-isosorbide dinitrate group for the first 13 weeks. This group also experienced significantly increased oxygen consumption during exercise testing in the first year of therapy. The number of hospitalizations was similar for both groups. These results confirm previous findings previous regarding the beneficial effects of vasodilators on reducing mortality in patients with congestive heart failure. Enalapril was more effective in reducing mortality, while hydralazine-isosorbide dinitrate had more favorable effects on some physiologic variables. A combination of the two drugs might provide even better results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Enalapril

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ACE inhibitors - a cornerstone of the treatment of heart failure

Article Abstract:

Drug therapy for congestive heart failure has evolved dramatically in the past few decades. Digitalis and diuretic agents were the major drugs used to treat this condition for many years. Vasodilators, drugs that cause blood vessels to open wider, were first suggested as a treatment for congestive heart failure as early as 1956. They were initially shown to be effective in treating acute heart failure, but as recently as 1983, in an editorial in The New England Journal of Medicine, it was pointed out that their effectiveness in prolonging the survival of heart failure patients had not been proven. The editorial was in response to the approval by the Food and Drug Administration of the angiotensin-converting-enzyme (ACE) inhibitor captopril. In the August 1, 1991 issue of The New England Journal of Medicine, two new studies report findings on the effectiveness of enalapril, another ACE inhibitor, in increasing survival rates in patients with mild-to-moderate congestive heart failure. A report from the Studies of Left Ventricular Dysfunction (SOLVD) assessed survival in patients treated with enalapril or a placebo. Survival rates were greater in the enalapril group, particularly in the first six months after treatment was begun. The report by the Vasodilator-Heart Failure Trial (V-HeFT II) is their second study. In the first study from this group, vasodilator therapy with a hydralazine-nitrate combination increased survival rates in patients with congestive heart failure. In the current study, the hydralazine-isosorbide dinitrite combination was compared with enalapril. Results showed that survival rates were higher in the enalapril group, although both therapies were effective. The combination therapy was more beneficial, as measured by certain physiologic parameters. Taken together, these newly published studies demonstrate the effectiveness of ACE inhibitors and other vasodilators in treating congestive heart failure. Future work should focus on whether an ACE inhibitor alone or in combination with another type of vasodilator provides superior treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, ACE inhibitors, Angiotensin converting enzyme inhibitors, Congestive heart failure agents, editorial

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Combination of isosorbide dinitrate and hydralazine in blacks with heart failure

Article Abstract:

A study examining whether a fixed dose of both isosorbide dinitrate and hydralazine provides additional benefit in African-Americans with advanced heart failure is discussed. It is found that addition of a fixed dose of both isosorbide dinitrate plus hydralazine to standard therapy for heart failure including neurohormonal blockers is efficacious and increases survival among African-American patients with advanced heart failure.

United Kingdom, Science & research, Research, Diagnosis, Heart failure

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