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Cited by 85Heart Failure Treatment and ManagementChronic Kidney Disease and DiabetesHeart rate and cardiovascular health

Effects of enalapril in systolic heart failure patients with and without chronic kidney disease: insights from the SOLVD Treatment trial

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Bowling, C. Barrett, Sanders, Paul W., Allman, Richard M., Rogers, William J., Patel, Kanan, Aban, Inmaculada B., Rich, Michael W., Pitt, Bertram +4 more·2013·International Journal of Cardiology
DOI 10.1016/j.ijcard.2011.12.056PMC PMC3395757
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Abstract

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 ≤ 2.5mg/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. /L, both). Conclusions Enalapril reduces mortality and hospitalization in SHF patients without significant heterogeneity between those with and without CKD.

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  • Early diagnosis of low EF, particularly in asymptomatic patients, is critical in reducing lifetime risk of morbidity and mortality.

    “Early diagnosis of low EF, particularly in asymptomatic patients, is critical in reducing lifetime risk of mobility and mortality.[15][16][17]”

    From Clinician Adoption of an Artificial Intelligence Algorithm to Detect Left Ventricular Systolic Dysfunction in Primary Care. (2022) · cites this paper as [15]

    The Introduction and Discussion report that treatment with enalapril reduces mortality and hospitalization in patients with systolic heart failure and reduced EF. But the Methods describe a predominantly symptomatic trial population, and the paper does not establish that early diagnosis—particularly in asymptomatic patients—reduces lifetime risk. (LLM, conf=0.82)

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  1. [15]Ahmed A Rich MW Sanders PW Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study Am J Cardiol 2007 99 393 8 17261405 PMC2708087

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Authors
Bowling, C. B., Sanders, P. W., Allman, R. M., Rogers, W. J., Patel, K., Aban, I. B., Rich, M. W., Pitt, B., White, M., Bakris, G. C., Fonarow, G. C., & Ahmed, A.
Affiliations
  • University of Alabama at Birmingham (US)
  • Washington University in St. Louis (US)
  • University of Michigan (US)
  • Université de Montréal (CA)
  • University of Chicago (US)
  • University of California, Los Angeles (US)
ORCID
Venue
International Journal of Cardiology
Publisher
Elsevier BV
Published
2013-07
Volume
167
Issue
1
Pages
151-156
ISSN
0167-5273 (ISSN-L)
DOI
10.1016/j.ijcard.2011.12.056
PMC
PMC3395757
OpenAlex
W1972592757
Cited by
85
References
27
Citations by year
2026: 5 · 2025: 8 · 2024: 12 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 5 · 2019: 12 · 2018: 3 · 2017: 3 · 2016: 2 · 2015: 3 · 2014: 6 · 2013: 5 · 2012: 1
FWCI
3.09
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • International Journal of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5ul1rr025777-04)
  • National Heart, Lung, and Blood Institute (R01-HL085561-S, R01HL097047, R01HL085561)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK046199, P30DK079337)
  • National Center for Research Resources (5UL 1RR025777, UL1-RR-025777)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
Keywords
enalapril, heart failure with reduced ejection fraction, chronic kidney disease, ACE inhibitors, SOLVD trial, all-cause mortality, cardiovascular hospitalization, creatinine elevation, left ventricular dysfunction, renin-angiotensin system blockade, renal dose adjustment
MeSH terms
Aged, Angiotensin-Converting Enzyme Inhibitors, Double-Blind Method, Enalapril, Female, Follow-Up Studies, Hospitalization, Humans, Male, Middle Aged, Treatment Outcome, Renal Insufficiency, Chronic, Heart Failure, Systolic

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