Author + information
- Received August 13, 1984
- Revision received January 7, 1985
- Accepted January 15, 1985
- Published online July 1, 1985.
- Mark A. Creager, MD, FACCa,
- Barry M. Massie, MD, FACC,
- David P. Faxon, MD, FACC,
- Scott D. Friedman, MD,
- Barry L. Kramer, MD,
- Donald A. Weiner, MD, FACC,
- Thomas J. Ryan, MD, FACC,
- Nina Topic, RN and
- Caroline D. Melidossian, RN
- ↵aAddress for reprint: Mark A. Creager, MD, Division of Vascular Medidicine and Atherosclerosis, Bringham and Women's Hospital, 75 Francis Street, Boston, Masschusetts 02118.
Enalapril is a recently developed angiotensin-converting enzyme inhibitor that improves cardiac function at rest in patients with congestive heart failure. This study investigated the acute effects of enalapril on the cardiovascular response to exercise, and then evaluated the long-term effects of enalapril on exercise capacity and functional status during a 12 week placebo-controlled trial in patients with heart failure. Ten patients underwent hemodynamic monitoring while at rest and during incremental bicycle exercise before and after 5 to 10 mg of enalapril orally. At rest, enalapril decreased mean blood pressure 13% (p < 0.01) and systemic vascular resistance 20% (p < 0.05) and increased stroke volume index 21% (p < 0.01). During maximal exercise, enalapril decreased systemic vascular resistance and increased both cardiac and stroke volume indexes. Enalapril acutely increased exercise duration (p < 0.05) and maximal oxygen consumption (p <0.001).
These 10 patients and an additional 13 patients were then randomized to either placebo or enalapril treatment and followed up for 2 weeks. Of the 11 patients assigned to active treatment, 73% considered themselves improved compared with 25% of the patients assigned to placebo treatment (p < 0.02). During long-term treatment, exercise capacity increased in patients receiving enalapril (p < 0.001) but was unchanged in patients receiving placebo (intergroup difference, p < 0.05). During long-term treatment, no adverse effects of enalapril occurred. Thus, enalapril improves cardiac function at rest and during exercise. Compared with placebo, maintenance therapy with enalapril results in symptomatic improvement and increased exercise capacity.
- Received August 13, 1984.
- Revision received January 7, 1985.
- Accepted January 15, 1985.
- American College of Cardiology Foundation