Failure of an ACE inhibitor to improve exercise tolerance - A randomized study of trandolapril

Background There has been conflicting evidence of the effect of angiotensin-converting enzyme (ACE) inhibitors on exercise tolerance. Meta-analysis of published results has suggested that a beneficial effect of ACE inhibitors is demonstrated if a trial design is adequate. Setting Multicentre International Trial. Methods In a double-blind, randomized, multicentre trial, 292 patients with moderate (New York Heart Association Grades II and III) heart failure were treated with trandolapril or placebo in addition to diuretics, and followed for 16 weeks. Exercise tolerance on a treadmill was assessed at baseline and after 4, 8, 12 and 16 weeks of treatment. Both a modified Bruce and a modified Naughton protocol were used. Results Exercise tolerance improved in both treatment groups, with no significant benefit from trandolapril treatment. Conclusion Trandolapril does not in tolerance as measured by treadmill testing.