CAPTOPRIL TREATMENT OF CHRONIC HEART-FAILURE IN THE VERY OLD

Background. The safety and efficacy of angiotensin-converting enzyme i nhibitors for very old patients with chronic heart failure have been l ess well documented than for younger patients. Methods. A prospective, randomized double-blind, placebo-controlled study of captopril, 25 mg twice daily, was designed. Fifty patients (mean age 84.2 +/- 5.2) par ticipated. The degree of chronic heart failure (according to the Bosto n Study Group rating), the distance walked in 6 minutes, and the occur rence of uncontrolled heart failure and adverse reactions were used as main outcome measures. Results. Significantly more patients receiving placebo developed uncontrolled heart failure than patients receiving captopril (p = .022). In an intention to treat analysis, the first and last evaluations of the degree of chronic heart failure were compared . A significantly different evolution was observed between the two tre atment groups (p < .001), with a significant improvement only in the c aptopril-treated patients (p < .001). The distance walked in 6 minutes improved significantly only in the captopril group (p = .004). The on ly adverse reaction was rash in two patients receiving captopril. Conc lusion. The study gives further evidence that angiotensin-converting e nzyme inhibitor treatment for very old patients with chronic heart fai lure is useful.