Effects of enalapril in systolic heart failure patients with and without chronic kidney disease: insights from the SOLVD Treatment trial.

Abstract

BACKGROUND:

Angiotensin-converting enzyme inhibitors improve outcomes in systolic heart failure (SHF). However, doubts linger about their effect in SHF patients with chronic kidney disease (CKD).

METHODS:

In the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial, 2569 ambulatory chronic HF patients with left ventricular ejection fraction ≤ 35% and serum creatinine level ≤ 2.5mg/dl were randomized to receive either placebo (n=1284) or enalapril (n=1285). Of the 2502 patients with baseline serum creatinine data, 1036 had CKD (estimated glomerular filtration rate <60 ml/min/1.73 m(2)).

RESULTS:

Overall, during 35 months of median follow-up, all-cause mortality occurred in 40% (502/1252) and 35% (440/1250) of placebo and enalapril patients, respectively (hazard ratio {HR}, 0.84; 95% confidence interval {CI}, 0.74-0.95; p=0.007). All-cause mortality occurred in 45% and 42% of patients with CKD (HR, 0.88; 95% CI, 0.73-1.06; p=0.164), and 36% and 31% of non-CKD patients (HR, 0.82; 95% CI, 0.69-0.98; p=0.028) in the placebo and enalapril groups, respectively (p for interaction=0.615). Enalapril reduced cardiovascular hospitalization in those with CKD (HR, 0.77; 95% CI, 0.66-0.90; p<0.001) and without CKD (HR, 0.80; 95% CI, 0.70-0.91; p<0.001). Among patients in the enalapril group, serum creatinine elevation was significantly higher in those without CKD (0.09 versus 0.04 mg/dl in CKD; p=0.003) during first year of follow-up, but there was no differences in changes in systolic blood pressure (mean drop, 7 mm Hg, both) and serum potassium (mean increase, 0. /L, both).

CONCLUSIONS:

Enalapril reduces mortality and hospitalization in SHF patients without significant heterogeneity between those with and without CKD.

• Authors: C Barrett Bowling, Paul W Sanders, Richard M Allman, William J Rogers, Kanan Patel, Inmaculada B Aban, Michael W Rich, Bertram Pitt, Michel White, George C Bakris, Gregg C Fonarow, Ali Ahmed
• Journal: International journal of cardiology (Int J Cardiol) Vol. 167 Issue 1 Pg. 151-6 (Jul 15 2013) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 22257685 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Published by Elsevier Ireland Ltd.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Enalapril

Topics

• Aged
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Double-Blind Method
• Enalapril (therapeutic use)
• Female
• Follow-Up Studies
• Heart Failure, Systolic (drug therapy, mortality)
• Hospitalization (trends)
• Humans
• Male
• Middle Aged
• Renal Insufficiency, Chronic (drug therapy, mortality)
• Treatment Outcome