Once Daily Dosing of Enalapril in Congestive Heart Failure

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Abstract
Enalapril 40 mg or tolerated dose was given once daily to 21 patients with congestive heart failure (CHF), NYHA class III, in addition to treatment with digoxin and/or diuretics. After an 8-week open period, 19 patients were randomized to continue enalapril or to receive a placebo in a double-blind manner. After the first enalapril dose of 10 mg, maximal reduction of blood pressure (BP) occurred after 4 hours (mean 34/17 mmHg; p < 0.001). No further reduction was found after higher doses. After the open period significant improvement was shown as judged by NYHA class (p < 0.01), stroke volume (p < 0.05), maximal working capacity (p < 0.05), heart volume (p < 0.01) and maximum rate pressure product (RPPmax) (p < 0.001). Urinary aldosterone markedly decreased (p < 0.01), whereas serum potassium and serum creatinine slightly increased (p < 0.05). At the end of the blind period enalapril was superior to placebo concerning NYHA class (p < 0.01), heart volume (p < 0.05) and RPPmax (p < 0.05). Other parameters, including aldosterone in urine, did not differ between the groups. Carry-over effects may have diminished the differences between enalapril and placebo. Diarrhea (n = 5) and hypotension (n = 5) were the most common side-effects. Overall, enalapril was well tolerated and seems to be useful in single daily doses in the treatment of CHF.