Neurohormonal and clinical responses to high- versus low-dose enalapril therapy in chronic heart failure
W. H. Wilson Tang, MD*,
Randall H. Vagelos, MD*,
Yin-Gail Yee, BS*,
Claude R. Benedict, MD ,
Kathy Willson, RN*,
Charles L. Liss, MS ,
Patrice LaBelle, MD and
Michael B. Fowler, MBBS, FRCP, FACC*,*
* Stanford University Medical School, Stanford, California, USA
University of Texas Medical School, Houston, Texas, USA
Merck & Co., West Point, Pennsylvania, USA
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Figure 1 Study protocol and withdrawal. Data are expressed as the number of patients withdrawn/discontinued from the trial. HD = high-dose; LD = low-dose; qd = once daily; bid = twice daily; peak VO2 = peak oxygen consumption.
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Figure 2 Serum angiotensin-converting enzyme (ACE) activity after high-dose versus low-dose enalapril therapy. Only statistically significant results are reported from the comparisons: 1) between groups; 2) within a group (baseline to end of study); and 3) within a group (pre-dose to post-dose). In the first two comparisons, the p value represents both pre- and post-dose results, unless otherwise stated. *p < 0.05 pre-dose versus post-dose. Open bars = pre-dose ACE activity; solid bars = post-dose ACE activity.
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Figure 3 Plasma angiotensin II (AT-II) levels after high-dose versus low-dose enalapril therapy. Only statistically significant results are reported from the comparisons: 1) between groups; 2) within a group (baseline to end of study); and 3) within a group (pre-dose to post-dose). *p < 0.05 pre-dose versus post-dose. Open bars = pre-dose AT-II level; solid bars = post-dose AT-II level.
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Figure 4 Serum aldosterone levels after high-dose versus low-dose enalapril therapy. Only statistically significant results are reported from the comparisons: 1) between groups; 2) within a group (baseline to end of study); and 3) within a group (pre-dose to post-dose). *p < 0.05 pre-dose versus post-dose. Open bars = pre-dose aldosterone level; solid bars = post-dose aldosterone level.
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Figure 5 Plasma renin activity (PRA) after high-dose versus low-dose enalapril therapy. Only statistically significant results are reported from the comparisons: 1) between groups; 2) within a group (baseline to end of study); and 3) within a group (pre-dose to post-dose). *p < 0.05 pre-dose versus post-dose. Open bars = pre-dose PRA level; solid bars = post-dose PRA level.
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Figure 6 Post-dose serum aldosterone escape and plasma AT-II reactivation after high-dose versus low-dose enalapril therapy at the end of the study (week 34).
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