Adverse effects of enalapril in the Studies of Left Ventricular Dysfunction (SOLVD). SOLVD Investigators.

In the Studies of Left Ventricular Dysfunction (LVD), enalapril or placebo was administered in a double-blind fashion to 6797 participants with ejection fraction < or = 0.35. During 40 months' average follow-up, 28.1% of participants randomized to enalapril reported side effects compared with 16.0% in the placebo group (p < 0.0001). Enalapril use was associated with a higher rate of symptoms related to hypotension (14.8% vs 7.1%, p < 0.0001), azotemia (3.8% vs 1.6%, p < 0.0001), cough (5.0% vs 2.0%, p < 0.0001), fatigue (5.8% vs 3.5%, p < 0.0001), hyperkalemia (1.2% vs 0.4%, p = 0.0002), and angioedema (0.4% vs 0.1%, p < 0.05). Side effects resulted in discontinuation of blinded therapy in 15.2% of the enalapril group compared with 8.6% in the placebo group (p < 0.0001). Thus enalapril is well tolerated by patients with LVD; however, hypotension, azotemia, cough, fatigue, and other side effects result in discontinuation of therapy in a significant minority of patients.

[1]  M. Rousseau,et al.  Effects of long-term enalapril therapy on left ventricular diastolic properties in patients with depressed ejection fraction. SOLVD Investigators. , 1993, Circulation.

[2]  B. Brundage,et al.  Immediate and Sustained Hemodynamic and Clinical Improvement in Chronic Heart Failure by an Oral Angiotensin‐converting Enzyme Inhibitor , 1980, Circulation.

[3]  E. J. Brown,et al.  Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. , 1992, The New England journal of medicine.

[4]  K. Swedberg,et al.  Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). , 1988, The American journal of cardiology.

[5]  S. Yusuf,et al.  Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. , 1992, The New England journal of medicine.

[6]  S. Gottlieb,et al.  Adverse effects of converting-enzyme inhibition in patients with severe congestive heart failure: pathophysiology and management. , 1986, Postgraduate medical journal.

[7]  D. Mason,et al.  Efficacy of oral angiotensin-converting enzyme inhibition with captopril therapy in severe chronic normotensive congestive heart failure. , 1981, American heart journal.

[8]  M. Wilén,et al.  Effects of enalapril, a new angiotensin-converting enzyme inhibitor, in a controlled trial in heart failure. , 1985, Journal of the American College of Cardiology.

[9]  M. Packer,et al.  Hemodynamic patterns of response during long-term captopril therapy for severe chronic heart failure. , 1983, Circulation.

[10]  D. Sharpe,et al.  Enalapril in patients with chronic heart failure: a placebo-controlled, randomized, double-blind study. , 1984, Circulation.

[11]  B. Pitt,et al.  Effect of enalapril on myocardial infarction and unstable angina in patients with low ejection fractions , 1992, The Lancet.

[12]  W. Rogers,et al.  Initial blood pressure response to enalapril in hospitalized patients (Studies of Left Ventricular Dysfunction [SOLVD]). , 1991, American Journal of Cardiology.

[13]  Salim Yusuf,et al.  Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. , 1991, The New England journal of medicine.

[14]  R. Parish,et al.  Adverse Effects of Angiotensin Converting Enzyme (ACE) Inhibitors , 1992, Drug safety.

[15]  E. Espiner,et al.  Haemodynamic, hormonal, and electrolyte effects of enalapril in heart failure. , 1983, British heart journal.

[16]  T. Ryan,et al.  Angiotensin Converting Enzyme Inhibition in Patients with Congestive Heart Failure , 1978, Circulation.

[17]  N. Hollenberg,et al.  Sustained effectiveness of converting-enzyme inhibition in patients with severe congestive heart failure. , 1980, The New England journal of medicine.

[18]  J. Kostis.  Angiotensin converting enzyme inhibitors. II. Clinical use. , 1988, American heart journal.

[19]  B. Greenberg,et al.  Studies of Left Ventricular Dysfunction (SOLVD). , 1993, The American journal of geriatric cardiology.

[20]  S. Yusuf,et al.  Tolerability of enalapril initiation by patients with left ventricular dysfunction: results of the medication challenge phase of the Studies of Left Ventricular Dysfunction. , 1994, American heart journal.

[21]  S. Yusuf,et al.  Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dysfunction in patients with heart failure. SOLVD Investigators. , 1992, Circulation.

[22]  M. Kronenberg,et al.  Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators. , 1993, Circulation.

[23]  G. Murray,et al.  Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators , 1993 .

[24]  A. Crisp.  'Biological' depression; because sleep fails? , 1986, Postgraduate medical journal.

[25]  F. Tristani,et al.  A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. , 1991, The New England journal of medicine.

[26]  J. Halperin,et al.  Angiotensin inhibition in severe heart failure: acute central and limb hemodynamic effects of captopril with observations on sustained oral therapy. , 1981, American heart journal.