Advertisement

Initial blood pressure response to enalapril in hospitalized patients (studies of left ventricular dysfunction [SOLVD])

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Studies of Left Ventricular Dysfunction (SOLVD) is a randomized trial of enalapril versus placebo in reducing mortality in patients with cardiac dysfunction (defined as left ventricular ejection fraction ≤35%). Before randomization, patients at risk for hypotension were hospitalized for a test dose of 2.5 mg of enalapril administered orally at baseline and again 12 hours later. As of February 1989, 89 of 7,539 (1.2%) patients had been studied during hospitalization. Baseline systolic and diastolic blood pressures were 115 ± 18 and 73 ± 10 mm Hg, respectively. After enalapril, systolic blood pressure decreased slightly but significantly 8 to 20 hours after the initial dose (mean reduction 8 to 11 mm Hg). In this highly selected group of 89 patients, symptoms relating to decrease in blood pressure were noted in 13 (15%). It is emphasized that most patients with cardiac dysfunction readily tolerate enalapril. However, the agent should be administered with caution to patients with advanced congestive failure and diminished baseline blood pressure, owing to a significant incidence of symptomatic hypotension.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Faxon DP
        • Creager MA
        • Halperin JL
        • Gavras H
        • Coffman JD
        • Ryan TJ
        Central and peripheral hemodynamic effects of angiotensin inhibition in patients with refractory congestive heart failure.
        Circulation. 1980; 61: 925-930
        • Creager MA
        • Massie BM
        • Faxon DP
        • Friedman SD
        • Kramer BL
        • Weiner DA
        • Ryan TJ
        • Topic N
        • Melidossian CD
        Acute and long-term effects of enalapril on the cardiovascular response to exercise and exercise tolerance in patients with congestive heart failure.
        J Am Coll Cardiol. 1985; 6: 163-170
        • Captopril Multicenter Research Group
        A placebo-controlled trial of captopril in refractory chronic congestive heart failure.
        J Am Coll Cardiol. 1983; 2: 755-763
        • Captopril-Digoxin Multicenter Research Group
        Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure.
        JAMA. 1988; 259: 539-544
        • CONSENSUS (Cooperative North Scandinavian Enalapril Survival Study) Trial Study Group
        Effects of enalapril on mortality in severe congestive heart failure.
        N Engl J Med. 1987; 316: 1429-1435
        • The SOLVD Investigators
        Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.
        N Engl J Med. 1991; 325: 293-302
        • Inman WHW
        • Rawson NSB
        • Wilton LV
        • Pearce GL
        • Speirs CJ
        Postmarketing surveillance of enalapril. I. Results of prescription-event monitoring.
        Br Med J. 1988; 297: 826-829
        • Edwards JR
        • Coulter DM
        • Beasley DMG
        • MacIntosh D
        Captopril: 4 years of post marketing surveillance of all patients in New Zealand.
        Br J Clin Pharmacol. 1987; 23: 529-536
        • McFate Smith W
        • Kulaga SF
        • Monclor F
        • Pingeon R
        • Walker JF
        Overall tolerance and safety of enalapril.
        J Hypertens. 1984; 9 (suppl): S-113-S-117
        • Rucinska EJ
        • Small R
        • Mulcahy WS
        • Snyder DL
        • Rodel PV
        • Rush JE
        • Smith RD
        • Walker JF
        • Irvin JD
        Tolerability of long term therapy with enalapril maleate in patients resistant to other therapies and intolerant to captopril.
        Med Toxicol Adverse Drug Experience. 1989; 4: 144-152
        • Kjekshus J
        • Swedberg K
        Enalapril for congestive heart failure.
        Am J Cardiol. 1989; 63: 26D-32D
        • Warner NJ
        • Rush JE
        • Keegan ME
        Tolerability of enalapril in congestive heart failure.
        Am J Cardiol. 1989; 63: 33D-37D
        • Dickstein K
        • Aarsland T
        • Tjelta K
        • Cirillo VJ
        • Gomez HJ
        A comparison of hypotensive responses after oral and intravenous administration of enalapril and lisinopril in chronic heart failure.
        J Cardiovasc Pharmacol. 1987; 9: 705-710
        • Cleland JGF
        • Dargie HJ
        • McAlpine H
        • Ball SG
        • Morton JJ
        • Robertson JIS
        • Ford I
        Severe hypotension after first dose of enalapril in heart failure.
        Br Med J. 1985; 291: 1309-1312
        • Packer M
        • Lee WH
        • Yushak M
        • Medina N
        Comparison of captopril and enalapril in patients with severe chronic heart failure.
        N Engl J Med. 1986; 315: 847-853
        • Lee DC
        • Johnson RA
        • Bingham JB
        • Leahy M
        • Dinsmore RE
        • Goroll AH
        • Newell JB
        • Strauss HW
        • Haber E
        Heart failure in outpatients. A randomized trial of digoxin versus placebo.
        N Engl J Med. 1982; 306: 699-705
        • Dzau VJ
        • Colucci WS
        • Hollenberg NK
        • Williams GH
        Relation of the reninangiotensin-aldosterone system to clinical state in congestive heart failure.
        Circulation. 1981; 63: 645-651
        • Ader R
        • Chatterjee K
        • Ports T
        • Brundage B
        • Hiramatsu B
        • Parmley W
        Immediate and sustained hemodynamic and clinical improvement in chronic heart failure by an oral angiotensin-converting enzyme inhibitor.
        Circulation. 1980; 61: 931-937
        • Dzau VJ
        • Colucci WS
        • Williams GH
        • Curfman G
        • Meggs L
        • Hollenberg NK
        Sustained effectiveness of converting-enzyme inhibition in patients with severe congestive heart failure.
        N Engl J Med. 1980; 302: 1373-1379