Enalapril congestive heart failure

The SOLVD Investigators, Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure, N. Engl.. Med., 325, 293-302,1991. 

Cohn IN, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure, [see comment]. N. Engl. J. Med. 1991 325 303-10. 

CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987 316 1429-1435. 

While essentially all ACE inhibitors have a similar mechanism of action and therefore exhibit similar efficacy in the treatment of hypertension and congestive heart failure, these drugs differ slightly in their pharmacokinetic profiles. Enalapril, lisinopril, and quinapril are excreted primarily by the kidney, with minimal liver metabolism, while the other prodrug compounds are metabolized by the liver and renally excreted. Thus, in patients with renal insufficiency, the half-life of renally excreted ACE inhibitors is prolonged. In addition, patients with impaired liver func-... 

Enalapril maleate is an orally active angiotensin converting enzyme (ACE) inhibitor, it lowers peripheral vascular resistance without causing an increase in heart rate. The maleate salt (enalapril) allows better absorption after oral administration. It is an ideal drug for hypertensive patients who are intolerant to beta-blocker therapy. It also shows promise in the treatment of congestive heart failure. Following oral adminishation, enalapril is rapidly absorbed and hydrolysed to... 

As noted earlier, lithium is contraindicated in patients with unstable congestive heart failure or the sick sinus node syndrome ( 307, 328). In older patients or those with prior cardiac histories, a pretreatment ECG should be obtained. Except for the potential adverse interactions with diuretics, the concomitant use of other cardiac drugs is generally safe. Because verapamil may lower serum levels of lithium, however, more careful monitoring may be required to assure continued therapeutic effects (329). Some data also indicate that verapamil may predispose to lithium neurotoxicity. Conversely, increased lithium levels leading to toxicity has occurred with methyidopa and enalapril. When antihypertensive therapy is necessary, b-blockers are a reasonable choice when lithium is coadministered. 

Drug Class Angiotensin-converting enzyme [ACE] inhibitors Suffix -pril Common Examples Captopril, enalapril Primary Indication or Desired Effect (Chapter in Parentheses) Antihypertensive [21], congestive heart failure [24]... 

Congestive heart failure (CHF), other high-risk patients Angiotensin-converting enzyme (ACE) inhibition Enalapril Captopril Ramipril Reduction in cardiovascular, all-cause mortality reduced hospitalizations and recurrent CHF in patients post-MI, with CHF and with decreased left ventricular ejection fraction (LVEF) CONSENSUS SAVE SOLVD AIRE HOPE >23,000 14... 

The CONSENSUS study was performed in 253 patients with severe congestive heart failure. They were randomized to receive either placebo (n = 126) or enalapril (n = 127), from 2.5 mg bid to 20 mg bid with a follow-up period that averaged 182 days. By the end of the study, there had been 68 deaths in the placebo group and 50 in the enalapril group (p =. 003) (313). Later, enalapril was shown to be superior to hydralazine-isosorbide dinitrate (314, 315). 

With the data included in the overview of Garg et al. (316), it is possible to calculate that 18 patients need to be treated for 90 days to avoid one death or one hospitalization for congestive heart failure (95% confidence interval [Cl] 16-23). This meta-analysis includes 32 trials with the ACE inhibitors captopril, enalapril, lisinopril, quinapril, ramipril, and perindopril. It is likely that high doses (for instance, lisinopril 35 mg daily) are more effective than low doses (lisinopril 5 mg daily) (302). Treating 30 patients for 4 years with a high dose of lisinopril (95% Cl 16-509) will avoid one hospitalization for cardiovascular reasons or one death in comparison with a low dose, without increasing the number of adverse effects requiring withdrawal from treatment. 

Effect of enalapril on mortality of patients with congestive heart failure. 

McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J. Comparison of candesartan, enalapril, and their combination in congestive heart failure randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators. Circulation 1999 100(10) 1056-64. 

Kjekshus J, Swedberg K. Enalapril for congestive heart failure. Am J Cardiol 1989 63(8) D26-32. 

Enalapril Vasodilatation in congestive heart failure 0.5 mg/kg p.o. once daily ... 

Dickstein K. Pharmacokinetics of enalapril in congestive heart failure. Drugs, 1986, 32 (Suppl) 5 40-44. 

Enalapril is an ACE inhibitor that competitively inhibits angiotensin I-converting enzyme, preventing conversion of angiotensin I to angiotensin 11, a potent vasoconstrictor that also stimulates release of aldosterone. It results in deaeases in BP, reduced sodium absorption, and potassium retention. Enalapril is indicated in the treatment of hypertension and symptomatic congestive heart failure (CHE) in combination with diuretics and digitalis and asymptomatic left ventricular dysfunction. 

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