Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus - Results from the ATLAS trial

Aims An analysis was designed to determine whether chronic heart failure pa tients at high cardiovascular risk benefited to the same extent from high-d ose lisinopril as the whole ATLAS population. Methods and Results A retrospective analysis was performed on high-risk hea rt failure patients in the Assessment of Treatment with Lisinopril And Surv ival (ATLAS) trial (total number of patients 3164) comparing high-dose (32. 5-35 mg.day(-1)) vs low-dose (2.5-5 mg.day(-1)) lisinopril for a median of 46 months. These high-risk patients included those with hypotension, hypona traemia, compromised renal function, the elderly and patients with diabetes mellitus at baseline. In the whole study population, high-dose lisinopril led to a trend in risk reduction of all-cause mortality (primary end-point P=0.128) and a significant risk reduction in all-cause mortality plus hospi talization (principal secondary end-point P=0.002). Subgroup analyses were performed for these end-points. Then were no consistent interactions betwee n age, baseline sodium, creatinine or potassium values, and treatment effec t. Diabetics showed a beneficial response to high-dose therapy that was at least as good as that in non-diabetics. The underlying higher morbidity/mor tality rates in diabetics mean that high-dose lisinopril has potential for a larger absolute clinical impact in these patients. Conclusion Long-term high-dose lisinopril was as effective and well-tolerat ed in high-risk patients, including those with diabetes mellitus, as for th e ATLAS study population as a whole. (C) 2000 The European Society of Cardi ology.