Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus. Results from the ATLAS trial.

Abstract

AIMS:

An analysis was designed to determine whether chronic heart failure patients at high cardiovascular risk benefited to the same extent from high-dose lisinopril as the whole ATLAS population.

METHODS AND RESULTS:

A retrospective analysis was performed on high-risk heart failure patients in the Assessment of Treatment with Lisinopril And Survival (ATLAS) trial (total number of patients 3164) comparing highdose (32.5-35 mg. day(-1)) vs low-dose (2.5-5 mg. day(-1)) lisinopril for a median of 46 months. These high-risk patients included those with hypotension, hyponatraemia, compromised renal function, the elderly and patients with diabetes mellitus at baseline. In the whole study population, high-dose lisinopril led to a trend in risk reduction of all-cause mortality (primary end-point P=0.128) and a significant risk reduction in all-cause mortality plus hospitalization (principal secondary end-point P=0.002). Subgroup analyses were performed for these end-points. There were no consistent interactions between age, baseline sodium, creatinine or potassium values, and treatment effect. Diabetics showed a beneficial response to high-dose therapy that was at least as good as that in non-diabetics. The underlying higher morbidity/mortality rates in diabetics mean that high-dose lisinopril has potential for a larger absolute clinical impact in these patients.

CONCLUSION:

Long-term high-dose lisinopril was as effective and well-tolerated in high-risk patients, including those with diabetes mellitus, as for the ATLAS study population as a whole.

• Authors: L Rydén, P W Armstrong, J G Cleland, J D Horowitz, B M Massie, M Packer, P A Poole-Wilson
• Journal: European heart journal (Eur Heart J) Vol. 21 Issue 23 Pg. 1967-78 (Dec 2000) ISSN: 0195-668X [Print] England
• PMID: 11071803 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2000 The European Society of Cardiology.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Lisinopril

Topics

• Aged
• Aged, 80 and over
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage)
• Chronic Disease
• Databases, Factual
• Diabetes Complications
• Drug Administration Schedule
• Female
• Heart Failure (complications, drug therapy, mortality)
• Hospitalization (statistics & numerical data)
• Humans
• Lisinopril (administration & dosage)
• Male
• Middle Aged
• New York (epidemiology)
• Randomized Controlled Trials as Topic
• Retrospective Studies
• Survival Analysis