Comparative efficacy of enalapril and digoxin in the treatment of patientswith moderate and severe heart failure and sinus rhythm: Double blind randomized multicenter study

Efficacy and safety of enalapril and digoxin were studied in a double blind randomized trial on 100 hydrochlorothiazide treated patients with moderate to severe heart failure and sinus rhythm. Fifty patients were randomized t o enalapril (5-20 mg/day) and 50 - to digoxin (0,125-0,25). After 24 weeks of treatment the following parameters were compared: rates of serious cardi ovascular complications and side effects, changes of clinical status, exerc ise tolerance, echocardiographic and biochemical parameters, quality of lif e, and subjective assessment of efficacy of therapy by physicians and patie nts with the use of 5 criteria. In each group 3 patients withdraw because o f complications or side effects. Both drugs significantly and approximately to the same degree improved NYHA class, exercise tolerance and myocardial contractility. Decrease of left ventricular diastolic dimension was signifi cant only in enalapril group (-3,8%, p=0,05). The only significant change o f biochemical parameters was increase of creatinine level (+7,3%, p=0,03) w ithin normal limits in enalapril treated patients. There was no significant difference between effects of drugs on quality of life. However according to 4 of 5 subjective criteria both doctors and patients preferred digoxin. Thus for short term (up to 6 months) treatment of patients in sinus rhythm with moderate to severe heart failure mg/day enalapril and digoxin were equ ally effective and safe. A suggestion was made that combined use of these d rugs could be expedient for long term treatment of such patients.