Table 3.
Effect of ACEI/ARB on heart failure
| Trial acronym (year of publication) | Population | Patient no. | Comparators | Mean follow-up duration | Major results |
|---|---|---|---|---|---|
| ACEI | |||||
| CONSENSUS (1987) The CONSENSUS Trial Study Group, 1987 | NYHA class IV | 253 | Enalapril (2.5–40 mg daily) versus placebo | 188 days | Enlapril was associated with 40% (P = 0.002) and 31% (P = 0.001) reduction in mortality at 6 months and 1 year respectively |
| SOLVD (1991) The SOLVD Investigators, 1991 | LVEF ≤ 35% Symptomatic | 2569 | Enalapril (2.5–20 mg daily) versus placebo | 41.4 months | Enalapril reduced mortality by 16% (P = 0.004) and combined end point of death or heart failure hospitalization by 26% (P < 0.0001) |
| SOLVD (1992) The SOLVD Investigators, 1992 | LVEF ≤ 35% Asymptomatic | 4228 | Enalapril (2.5–20 mg daily) versus placebo | 47.4 months | Enalapril reduced the risk of death and heart failure by 29% (P < 0.001) |
| V-HeFT II (1991) Cohn et al., 1991 | NYHA class II–III | 806 | Enalapril (10 mg daily) versus hydralazine (150 mg daily)/isorsobide dinitrate (80 mg twice daily) | 2.5 years | Enalapril reduced 2-year mortality by 28% (P = 0.02) |
| FEST (1995) Erhardt et al., 1995 | NYHA class II–III | 308 | Fosinopril (10–40 mg daily) versus placebo | 12 weeks | Fosinopril increased exercise tolerance and reduced worsening of heart failure (8 vs. 20%; P = 0.002) without change in mortality. |
| ARB | |||||
| ARCH-J (2003) Matsumori and ARCH-J Study Investigators, 2003 | ACEI intolerant | 305 | Candesartan (8 mg daily) versus placebo | 6 months | Candesartan reduced progression of heart failure by 67% (P < 0.001) and cardiovascular events by 53% (P < 0.01) |
| CHARM-alternative (2003) Granger et al., 2003 | ACEI intolerant; LVEF ≤ 40% | 2028 | Candesartan (4–16 mg daily) versus placebo | 33.7 months | Candesartan reduced the risk of cardiovascular deaths or heart failure admission by 23% (P < 0.001) |
| ELITE I (1997) Pitt et al., 1997 | ACEI naïve; LVEF ≤ 40%, | 722 | Losartan (50 mg daily) versus captopril (50 mg thrice daily) | 48 weeks | Losartan reduced all-cause mortality by 46% (P = 0.04) |
| ELITE II (2000) Pitt et al., 2000 | ACEI naïve, NYHA class II–IV; LVEF ≤ 40% | 3152 | Losartan (50 mg daily) versus captopril (50 mg thrice daily) | 555 days | Losartan and captopril had similar efficacy |
| SPICE (2000) Granger et al., 2000 | ACEI intolerant; LVEF ≤ 35% | 270 | Candesartan versus placebo | 12 weeks | No difference in cardiovascular end points |
| HEAAL (2009) Konstam et al., 2009 | ACEI intolerant, NYHA class II–IV; LVEF ≤ 40% | 3846 | Losartan 50 mg once daily versus 150 mg once daily | 4.7 years | Higher dose losartan was associated with reduced rate of death or heart-failure-related admissions (43 vs. 46%, P = 0.03) |