The cost and cardioprotective effects of enalapril in hypertensive patients with left ventricular dysfunction

This study examined the effect of enalapril on survival, resource use, and cost of care in patients with left ventricular dysfunction and hypertension using a retrospective analysis of patients who participated in the Studies of Left Ventricular Dysfunction (SOLVD). Among the 6797 SOLVD participants , 1917 patients had either elevated systolic (greater than or equal to 140 mm Hg) or diastolic (greater than or equal to 90 mm Hg) blood pressure. The rapy with enalapril was associated with a significant relative risk reducti on for mortality (RR = 0.819, 95% CI: 0.68 to 0.98; P = .03). This resulted in a gain of 0.11 years (95% CI: 0.00 to 0.20 years) of survival during th e average 2.8 year follow-up for this subgroup and was projected to result in a gain of 2.14 years (95% CI: 0.05 to 4.21 years) during the patient's l ifetime. Enalapril significantly reduced the risk of first hospitalization for heart failure by 37%, For all types of hospitalizations, there was an a verage reduction of 32 hospitalizations per 100 patients treated with enala pril during the trial period (95% CI: 11.8 to 52.2 hospitalizations avoided per 100 patients), resulting in an estimated net savings of $1656 per pati ent during the trial period (95% CI: increased cost of $191 to savings of $ 3502). Although the projected lifetime net savings of $1456 was not signifi cant (95% CI: increased cost of $9243 to saving of $12,527), evaluation of the cost per life year saved indicated that enalapril represented a cost-ef fective strategy. The estimated clinical benefit of enalapril among the hyp ertensive subgroup in SOLVD supports the recommendation that angiotensin co nverting enzyme (ACE) inhibitors should be considered as first line pharmac ologic therapy for hypertensive patients with left ventricular dysfunction. From both the clinical and economic viewpoints, ACE inhibitors provide imp ortant clinical benefits and are cost-effective. (C) 1998 American Journal of Hypertension, Ltd.