Efficacy of Enalapril for Prevention of Congestive Heart Failure in Dogs with Myxomatous Valve Disease and Asymptomatic Mitral Regurgitation
Clarence KvartJens HäggströmHenrik D. PedersenKerstin HanssonAnders ErikssonAnna‐Kaisa JärvinenAnna TidholmKarina BsenkoErik AhlgrenMikael LivesBjörn ÅbladT. FalkEllen BjerkåsSusanne GundlerPeter F. LordGudrun WegelandEva Thors AdolfssonJens Corfitzen
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We evaluated the long-term effect of early angiotensin-converting enzyme (ACE) inhibition (enalapril maleate) as monotherapy to postpone or prevent congestive heart failure (CHF) in asymptomatic dogs with mitral regurgitation (MR) attributable to myxomatous valvular disease (MVD) in a prospective, randomized, double-blinded, placebo-controlled multicenter trial involving 14 centers in Scandinavia. Two hundred twenty-nine Cavalier King Charles (CKC) Spaniels with MR attributable to MVD but no signs of CHF were randomly allocated to treatment with enalapril 0.25-0.5 mg daily (n = 116) or to placebo groups (n = 113). Each dog was evaluated by physical examination, electrocardiography, and thoracic radiography at entry and every 12 months (+/-30 days). The number of dogs developing heart failure was similar in the treatment and placebo groups (n = 50 [43%] and n = 48 [42%], respectively; P = .99). The estimated means, adjusted for censored observations, for the period from initiation of therapy to heart failure were 1,150 +/- 50 days for dogs in the treatment group and 1,130 +/- 50 days for dogs in the placebo group (P = .85). When absence or presence of cardiomegaly at the entrance of the trial was considered, there were still no differences between the treatment and placebo groups (P = .98 and .51, respectively). Multivariate analysis showed that enalapril had no significant effect on the time from initiation of therapy to heart failure (P = .86). Long-term treatment with enalapril in asymptomatic dogs with MVD and MR did not delay the onset of heart failure regardless of whether or not cardiomegaly was present at initiation of the study.Perindopril
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BACKGROUNDIn patients with heart failure, activation of the renin-angiotensin system is common and has been postulated to provide a stimulus for further left ventricular (LV) structural and functional derangement. We tested the hypothesis that chronic administration of the angiotensin converting enzyme (ACE) inhibitor enalapril prevents or reverses LV dilatation and systolic dysfunction among patients with depressed ejection fraction (EF) and symptomatic heart failure.METHODS AND RESULTSWe examined subsets of patients enrolled in the Treatment Trial of Studies of Left Ventricular Dysfunction (SOLVD). Fifty-six patients with mild to moderate heart failure underwent serial radionuclide ventriculograms, and 16 underwent serial left heart catheterizations, before and after randomization to enalapril (2.5-20 mg/day) or placebo. At 1 year, there were significant treatment differences in LV end-diastolic volume (EDV; p less than 0.01), end-systolic volume (ESV; p less than 0.005), and EF (p less than 0.05). Thes...
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Mitral valve regurgitation
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Abstract. We report the case of a patient who, 9 months after initiation of enalapril and hydrochlorothiazide combination treatment for hypertension, developed angio‐oedema with near fatal outcome. Our patient was successfully intubated using a flexible broncho‐fiberoscope. This case demonstrates that patients given an angiotensin‐converting enzyme (ACE) inhibitor may develop serious facial and laryngeal swelling even several months after the initiation of treatment. The occurrence of even mild swelling should lead to prompt cessation of the drug. Patients with incipient ACE inhibitor‐related angio‐oedema should, without any delay, be referred to hospital for emergency treatment.
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Leon, A. S. FACSM; McNally, C.; Casal, D.; Grim, R.; Crow, R.; Bell, C.; Hunninghake, D. B. Author Information
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1. The reproducibility of angiotensin converting enzyme inhibitor induced cough was examined in a double‐blind cross over study in patients previously shown to have exhibited this side effect. 2. Ninety‐ seven patients who had experienced angiotensin converting enzyme inhibitor cough within the last 2 years were challenged with enalapril 20 mg daily for 4 weeks to establish eligibility. Eighty‐eight of 97 (91%) patients experienced a repeat of their cough symptoms. Sixty‐four patients entered the double‐blind part of the study where they were treated with enalapril 20 mg and a renin inhibitor for up to 4 weeks in random order. These periods were separated by a minimum 4 week placebo wash out. 3. Of 59 evaluable patients who received enalapril a second time, 37 (62.7%) experienced cough again. Of 62 patients on the renin inhibitor 16 (25.8%) experienced cough, however as it was not equi‐ efficacious to enalapril no valid comparison could be made. 4. Angiotensin converting enzyme inhibitor cough is not reproducible within patients, as other factors are involved in the aetiology. Objective testing with blinded assessment together with symptom reporting, would give a more accurate measure of the incidence, and mechanism of this side effect.
Enalapril Maleate
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Angiotensin-converting enzyme (ACE) inhibitors, in conjunction with diuretic agents, have an established role in the management of moderate and severe heart failure due to left ventricular dysfunction. ACE inhibitor improves prognosis, symptoms and exercise performance. There have been some promising studies and one of the most widely quoted is the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS I), which demonstrated a 36% reduction in mortality with the ACE inhibitor, enalapril, versus placebo in patients with advanced heart failure. Over the last few years, we have received important information that seems to tell us that ACE inhibitors must be utilized if we hope to reduce mortality. An important topic is study the action of ACE inhibitors in improving prognosis, and the mechanism of the action.
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Abstract Abstract Ynaraja, E., Caro, A. and Montoya, J.A. 2002. Effect of treatment with enalapril, frusemide and a low-sodium diet on dogs with mitral regurgitation. J. Appl. Anim. Res., 22: 219–224. Thirty-five dogs with congestive heart failure due to chronic mitral valve disease were treated with frusemide (1 mg/kg bid), enalapril (0.4 mg/kg bid) and a low-sodium diet to evaluated the effects produced by combination of these drugs and to ascertain the possible negative effects following the use of these drugs. The treatment was safe, effective and well tolerated. No major side effects and no significant changes in haematological and biochemical variables were observed. Keywords: Dogmitral diseasefrusemideenalaprillow-sodium dietcardiologyCHF
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