THE EFFECT OF ENALAPRIL ON MORTAL AND MORBID EVENTS IN PATIENTS WITH HYPERTENSION AND LEFT-VENTRICULAR DYSFUNCTION

The objective of this study was to examine the effect of enalapril on morbid and mortal events in patients with left ventricular dysfunction and hypertension using a retrospective analysis of patients with systolic left ventricular dysfunction (ejection fraction less than or equal to 0.35) who participated in the Studies of Left Ventricular Dysfunction (SOLVD). Among the 6797 patients who were randomized to enalapril or placebo, 2652 had history of hypertension, 1508 had systolic blood pressure (SBP) greater than or equal to 140 mm Hg, and 985 had diastolic blood pressure (DBP) greater than or equal to 90 mm Hg. During average follow-up of 40 months, the rate of hospitalization for congestive heart failure was lower in the enalapril group than the placebo group among patients with history of hypertension (20.6% v 28.3%, P < .001, relative risk [RR] 0.664), and among those with elevated DBP (16.5% v 26.0%, P < .001, RR = 0.574), or SBP (19.5% v 27.7%, P < .001, RR = 0.647) at baseline. These risk ratios were similar to those observed in patients without history of hypertension (RR = 0.647). Also, the decreased rates of mortality, myocardial infarction, stroke, and unstable angina observed in SOLVD were seen, with similar relative risks, in patients with (RR = 0.927, 0.836, 0.979, 0.900, respectively) and without (RR = 0.866, 0.729, 0.775 and 0.743) history of hypertension as well in those with elevated SEP (RR = 0.841, 0.806, 0.707, 0.867) or DBP (RR = 0.791, 0.889, 0.755, 0.872) at baseline. This retrospective subset analysis of SOLVD indicates that angiotensin converting enzyme inhibitors are beneficial in patients with hypertension and left ventricular dysfunction and is compatible with the hypothesis that they should be used as first-line antihypertensive agents.