Effects of enalapril on mortality in severe congestive heart failure: Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS)

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To evaluate the influence of the angiotensin-converting enzyme inhibitor, enalapril (2.5 to 40 mg/day), on the prognosis of severe congestive heart failure, defined as New York Heart Association functional class IV, a double-blind study was undertaken in which 253 patients were randomized to receive either placebo (n = 126) or enalapril (n = 127) in addition to conventional treatment, including vasodilators. Follow-up averaged 188 days (range 1 day to 20 months). The reduction in crude mortality within 6 months (primary objective) was 40% in the enalapril-treated group (from 44 to 26%, p = 0.002) and within 1 year 31% (p = 0.001). By the end of the study, 68 subjects in the placebo group and 50 in the enalapril group had diedȁa reduction of 27% (p = 0.003). The entire reduction in total mortality (50%) was found in patients dying from progressive heart failure, whereas no difference was seen in the incidence of sudden cardiac death. There was a significant improvement in New York Heart Association classification in the enalapril group, together with a reduction in heart size and a reduced requirement for other heart failure medication. It is concluded that the addition of enalapril to conventional therapy in patients with severe congestive heart failure can reduce mortality and improve symptoms. The effect seems to be due to a reduction in death from progression of heart failure.

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    Citation Excerpt :

    Several and consistent data, from randomized controlled studies, have demonstrated the efficacy of RAAS blockade in HFrEF (Fig. 1). In 1998 the CONSENSUS study [4] firstly reported a 31% mortality risk reduction with enalapril in patients with advanced symptomatic HF; similarly, in the SOLVD trial [5] enalapril reduced by 16% all-cause mortality and by 26% the composite outcome of hospitalization due to HF (HHF) and death in patients with EF ≤35% and stable clinical conditions (NYHA class II/III). Subsequently, the trials SAVE [6], TRACE [7] and AIRE [8] confirmed the efficacy of captopril, trandolapril, and ramipril in post-myocardial infarction HF.

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