Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 167, Issue 1, Pages 151-156Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2011.12.056
Keywords
Enalapril; Heart failure; Chronic kidney disease
Categories
Funding
- NHLBI
- Birmingham/Atlanta Department of Veterans Affairs Geriatric Research Education and Clinical Center
- John A. Hartford Foundation
- Southeast Center of Excellence in Geriatric Medicine
- NIH [R01 DK046199, P30 DK079337, 5UL1 RR025777, R01-HL085561, R01-HL085561-S, R01-HL097047]
- Department of Veterans Affairs
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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 <= 2.5 mg/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, 0.2 mEq/L, both). Conclusions: Enalapril reduces mortality and hospitalization in SHF patients without significant heterogeneity between those with and without CKD. Published by Elsevier Ireland Ltd.
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