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Which drug should be used first in congestive heart failure -- a vasodilator or digoxin? Digoxin has the advantage of more than 200 years of use, but vasodilators have recently gained popularity. A multicenter, randomized, double-blind study of 300 patients with ejection fractions under 40 percent lends further support to the use of vasodilators. Patients were randomized to receive placebo, digoxin, or the vasodilator captopril.
As compared with placebo, captopril treatment was associated with improved exercise time and New York Heart Association class, but digoxin was not. In patients with more than 10 ventricular premature beats per hour, the number of premature beats declined in 45 percent of the captopril group and increased in 4 percent…