| A randomized double-blind trial of enalapril in older patients with heart failure and preserved ejection fraction: effects on exercise tolerance and arterial distensibility. | |
| | |
MedLine Citation:
|
PMID: 20516425 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Exercise intolerance is the primary symptom in older patients with heart failure and preserved ejection fraction (HFPEF); however, little is known regarding its mechanisms and therapy. METHODS AND RESULTS: Seventy-one stable elderly (70+/-1 years) patients (80% women) with compensated HFPEF and controlled blood pressure were randomized into a 12-month follow-up double-blind trial of enalapril 20 mg/d versus placebo. Assessments were peak exercise oxygen consumption; 6-minute walk test; Minnesota Living with HF Questionnaire; MRI; Doppler echocardiography; and vascular ultrasound. Compliance by pill count was excellent (94%). Twenty-five patients in the enalapril group versus 34 in the placebo group completed the 12-month follow-up. During follow-up, there was no difference in the primary outcome of peak exercise oxygen consumption (enalapril, 14.5+/-3.2 mL/kg/min; placebo, 14.3+/-3.4 mL/kg/min; P=0.99), or in 6-minute walk distance, aortic distensibility (the primary mechanistic outcome), left ventricle mass, or neurohormonal profile. The effect size of enalapril on peak exercise oxygen consumption was small (0.7%; 95% CI, 4.2% to 5.6%). There was a trend toward improved Minnesota Living with HF Questionnaire total score (P=0.07), a modest reduction in systolic blood pressure at peak exercise (P=0.02), and a marginal improvement in carotid arterial distensibility (P=0.04). CONCLUSIONS: In stable, older patients with compensated HFPEF and controlled blood pressure, 12 months of enalapril did not improve exercise capacity or aortic distensibility. These data, combined with those from large clinical event trials, suggest that angiotensin inhibition does not substantially improve key long-term clinical outcomes in this group of patients. This finding contrasts sharply with observations in HF with reduced EF and highlights our incomplete understanding of this important and common disorder. |
| | |
Authors:
|
Dalane W Kitzman; W Gregory Hundley; Peter H Brubaker; Timothy M Morgan; J Brian Moore; Kathryn P Stewart; William C Little |
Related Documents
:
|
10859285 - Impairment of ventilatory efficiency in heart failure: prognostic impact. 17003945 - Maximum oxygen uptake in adolescents as measured by cardiopulmonary exercise testing: a... 15317545 - Comparison of estimated and measured maximal oxygen uptake during exercise testing in p... 15903375 - Cordyceps sinensis- and rhodiola rosea-based supplementation in male cyclists and its e... 19042045 - Potential clinical use of cardiopulmonary exercise testing in obstructive sleep apnea h... 12848815 - The predictive value of exercise qrs duration changes for post-ptca coronary events. |
Publication Detail:
|
Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural Date: 2010-06-01 |
Journal Detail:
|
Title: Circulation. Heart failure Volume: 3 ISSN: 1941-3297 ISO Abbreviation: Circ Heart Fail Publication Date: 2010 Jul |
Date Detail:
|
Created Date: 2010-07-21 Completed Date: 2010-08-10 Revised Date: 2012-05-17 |
Medline Journal Info:
|
Nlm Unique ID: 101479941 Medline TA: Circ Heart Fail Country: United States |
Other Details:
|
Languages: eng Pagination: 477-85 Citation Subset: IM |
Affiliation:
|
Cardiology Section, Department of Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA. dkitzman@wfubmc.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Angiotensin-Converting Enzyme Inhibitors / administration & dosage* Blood Pressure / drug effects Carotid Arteries / physiology, radiography Dose-Response Relationship, Drug Double-Blind Method Drug Administration Schedule Echocardiography, Doppler Enalapril / administration & dosage* Exercise Tolerance / drug effects* Female Follow-Up Studies Geriatric Assessment Heart Failure / drug therapy*, ultrasonography Humans Magnetic Resonance Angiography Male Oxygen Consumption / drug effects Probability Quality of Life Reference Values Risk Assessment Stroke Volume / drug effects, physiology* Treatment Outcome Vasodilation / drug effects |
| Grant Support | |
ID/Acronym/Agency:
|
MO1RR07122/RR/NCRR NIH HHS; P30 AG021332-019001/AG/NIA NIH HHS; P30AG21332/AG/NIA NIH HHS; R01 AG012257-07/AG/NIA NIH HHS; R01AG12257/AG/NIA NIH HHS; R37 AG018915/AG/NIA NIH HHS; R37 AG018915-09/AG/NIA NIH HHS; R37AG18915/AG/NIA NIH HHS |
| Chemical | |
Reg. No./Substance:
|
0/Angiotensin-Converting Enzyme Inhibitors; 75847-73-3/Enalapril |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Urinary incontinence in older women.
Next Document: Effect of pregnancy on postural tachycardia syndrome.