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Evidence from more than 7000 heart-failure patients enrolled in randomized, clinical trials has shown that ACE-inhibitor therapy improves clinical status, cardiac function, morbidity, and mortality. Recent observations suggest, however, that ACE inhibition incompletely antagonizes angiotensin-II.
In an industry-sponsored, single-center study, researchers randomized 75 patients with advanced heart failure to receive twice-daily treatment with either low-dose (2.5 mg) or high-dose (20 mg) enalapril. Observation lasted 34 weeks (including titration and maintenance periods). Study endpoints included plasma, serum, and tissue neurohormone levels; NYHA class; metabolic exercise testing; echocardiographic analysis; and a composite clinical endpoint…