ENALAPRIL DECREASES PREVALENCE OF VENTRICULAR-TACHYCARDIA IN PATIENTSWITH CHRONIC CONGESTIVE-HEART-FAILURE

Background. Patients with heart failure have a high prevalence of seri ous arrhythmias and sudden cardiac death. Mdhods and Results. Male pat ients aged 18-75 years with chronic heart failure were randomized to e nalapril or hydralazine-isosorbide dinitrate. Short-term (4-hour to 8- hour) Holter tape recordings were performed before randomization, at 3 months, at 1 year, and yearly thereafter. Of 804 patients randomized to therapy, 715 had Holters at baseline. Couplets were noted in 56% ve rsus 60% and ventricular tachycardia (VT) (three or more consecutive v entricular premature beats) in 27% versus 29% of patients randomized t o enalapril versus hydralazine-isosorbide dinitrate, respectively. The presence of VT at 3 months, 1 year, and 2 years predicted significant ly higher mortality during the subsequent year (p<0.0001, p<0.001, and p<0.037, respectively). In the enalapril group, VT prevalence decreas ed by 27% at 1 year (p<0.02). A decrease in prevalence of VT was not s een in the hydralazine-isosorbide dinitrate group. New VT was seen in 11% of enalapril patients versus 24% of hydralazine-isosorbide dinitra te patients at 1 year (p<0.002). When compared with hydralazine-isosor bide dinitrate at 1 and 2 years, there was a 52% and 49% reduction, re spectively, in sudden deaths in the enalapril group. Thus, at 1 and 2 years, the decrease in sudden deaths in the enalapril group coincided with the decrease in VT prevalence and the decrease in new VT emergenc e. Conclusions. In patients with heart failure, VT and couplets predic t increased mortality. When compared with hydralazine-isosorbide dinit rate, enalapril decreases both the persistence of baseline VT at 3 mon ths and the emergence of new VT at 1 and 2 years. The reduction in VT prevalence parallels a reduction in sudden death. The effect of enalap ril on survival over hydralazine-isosorbide dinitrate may be related t o its ability to reduce prevalence of ventricular arrhythmia.