Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial
© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology..
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.
| Errataetall: |
CommentIn: Eur J Heart Fail. 2018 Feb;20(2):370-372. - PMID 28980436 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
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| Enthalten in: |
European journal of heart failure - 20(2018), 2 vom: 20. Feb., Seite 359-369 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lam, Phillip H [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 11.12.2018 Date Revised 25.02.2020 published: Print-Electronic CommentIn: Eur J Heart Fail. 2018 Feb;20(2):370-372. - PMID 28980436 Citation Status MEDLINE |
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| doi: |
10.1002/ejhf.937 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM276498720 |
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| 100 | 1 | |a Lam, Phillip H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial |
| 264 | 1 | |c 2018 | |
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| 500 | |a Date Completed 11.12.2018 | ||
| 500 | |a Date Revised 25.02.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Eur J Heart Fail. 2018 Feb;20(2):370-372. - PMID 28980436 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology. | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a CONCLUSION: In patients with HFrEF, the clinical benefits of ACE inhibitors appear to be similar at both below-target and target doses | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
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| 650 | 4 | |a ACE inhibitors | |
| 650 | 4 | |a Enalapril | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Placebo | |
| 650 | 4 | |a Target dose | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 650 | 7 | |a Enalapril |2 NLM | |
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| 700 | 1 | |a Forman, Daniel E |e verfasserin |4 aut | |
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| 700 | 1 | |a Blackman, Marc R |e verfasserin |4 aut | |
| 700 | 1 | |a Adamopoulos, Chris |e verfasserin |4 aut | |
| 700 | 1 | |a Kanonidis, Ioannis E |e verfasserin |4 aut | |
| 700 | 1 | |a Aban, Inmaculada B |e verfasserin |4 aut | |
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| 700 | 1 | |a Ahmed, Ali |e verfasserin |4 aut | |
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