October 2, 1986New England Journal of Medicine
Comparison of Captopril and Enalapril in Patients with Severe Chronic Heart Failure
Why the study?
Does enalapril compared to captopril improve outcomes or cause more adverse effects in patients with severe chronic heart failure?
Population
42 patients with severe chronic heart failure
Comparison
Enalapril 40 mg daily for one to three months… vs Captopril 150 mg daily for one to three months…
Design
RCT, randomly assigned
Follow-up
1 to 3 months
Authors
Discussion
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Member takes
Implication
Caution against large fixed doses of long-acting ACE inhibitors in severe HF; extends comparative safety data among agents.
Structured PICO
Does enalapril compared to captopril improve outcomes or cause more adverse effects in patients with severe chronic heart failure?
P
Population
42 patients with severe chronic heart failure
I
Intervention
Enalapril 40 mg daily for one to three months, with constant concomitant therapy of digoxin and diuretics
C
Comparator
Captopril 150 mg daily for one to three months, with constant concomitant therapy of digoxin and diuretics
O
Outcome
Hemodynamic and clinical characteristics, and systemic blood pressuresafety
In patients with severe chronic heart failure, large fixed doses of long-acting ACE inhibitors like enalapril may cause prolonged hypotension that compromises cerebral and renal function compared to short-acting agents like captopril.
Cite This Study
Packer et al. (1986) studied this question.