ENALAPRIL - A REVIEW OF QUALITY-OF-LIFE AND PHARMACOECONOMIC ASPECTS OF ITS USE IN HEART-FAILURE AND MILD-TO-MODERATE HYPERTENSION

Enalapril is an angiotensin converting enzyme (ACE) inhibitor with an established clinical profile. In patients with symptomatic heart failu re, enalapril reduces overall mortality, death from progressive heart failure and hospitalisation rates. In those with asymptomatic left ven tricular dysfunction, enalapril decreases the combined risk of death a nd development of heart failure, and the risk of death and hospitalisa tion. The effects of enalapril in reducing hospitalisation rates in sy mptomatic patients translate into net savings in healthcare costs in h eart failure. Enalapril also produces modest benefits in quality-of-li fe (QOL) parameters in patients with symptomatic heart failure as show n in well controlled studies. Its effects appear similar to those of h ydralazine plus isosorbide dinitrate. The influence of enalapril on qu ality of life in patients with asymptomatic disease is minimal but not deleterious. Enalapril generally either maintains or slightly improve s quality of life from baseline in patients with mild to moderate hype rtension. The drug appears to have a QOL profile that is more favourab le than that of propranolol and similar to those of most other compara tor drugs, as assessed by subjective measures of quality of life. Clar ification is required of its QOL profile relative to that of captopril , in view of conflicting results in the literature. The effects of ena lapril on cognitive and psychomotor function appear to resemble those of comparator agents. Thus, enalapril has modest beneficial effects on the quality of life of patients with symptomatic heart failure, while generally maintaining quality of life in patients with asymptomatic l eft ventricular dysfunction or mild to moderate hypertension. Enalapri l is a cost-effective treatment in heart failure that would be expecte d to yield considerable cost savings in this therapeutic area.