- Question
- Does adding an angiotensin-converting-enzyme inhibitor (enalapril) to conventional therapy reduce mortality and hospitalization in patients with chronic heart failure and reduced ejection fraction?
- Design
- Randomized, double-blind, placebo-controlled trial. Patients already receiving conventional heart failure treatment were assigned to placebo (n = 1284) or enalapril (n = 1285). Follow-up averaged 41.4 months.
- Population
- Patients with chronic congestive heart failure and an ejection fraction of 0.35 or less, receiving conventional treatment. About 90 percent were in NYHA functional class II or III.
- Intervention
- Enalapril at doses of 2.5 to 20 mg per day, added to conventional therapy.
- Control
- Placebo, added to conventional therapy.
- Primary outcome
- All-cause mortality; hospitalization was also assessed as an outcome.
- Results
- There were 510 deaths in the placebo group (39.7 percent) versus 452 in the enalapril group (35.2 percent), a 16 percent reduction in risk (95% CI, 5 to 26 percent; P = 0.0036). The largest reduction was seen in deaths attributed to progressive heart failure (251 with placebo vs. 209 with enalapril; 22 percent risk reduction). The combined outcome of death or hospitalization for worsening heart failure occurred in 736 placebo patients and 613 enalapril patients (26 percent risk reduction; P less than 0.0001).
- Conclusion
- Adding enalapril to conventional therapy significantly reduced mortality and hospitalizations for heart failure in patients with chronic heart failure and reduced ejection fraction.
- Why it matters
- It established ACE inhibitors as part of the foundational treatment of heart failure with reduced ejection fraction, with benefit on both survival and hospitalizations.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026