Temporal Patterns in the Medical Treatment of Congestive Heart Failure With Angiotensin-Converting Enzyme Inhibitors in Older Adults, 1989 Through 1995

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Abstract
THE EVIDENCE supporting the beneficial effect of angiotensin-converting enzyme (ACE) inhibitor treatment in patients with congestive heart failure (CHF) has been accumulating since the publication of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS)1 in 1987. The CONSENSUS demonstrated a significant 40% reduction in mortality for participants treated with enalapril maleate (mean final dose was 18.4 mg/d) compared with those treated with placebo. The largest study published since CONSENSUS, the Studies of Left Ventricular Dysfunction (SOLVD) Treatment Trial,2 randomly assigned 2569 participants with CHF to receive either enalapril or placebo. A significant 26% reduction in mortality was found in patients who received enalapril (mean final dose of 11.2 mg/d) compared with those who received placebo, and subjects with the lowest ejection fractions (EFs) appeared to benefit most from treatment.