ABSTRACT
CLINICAL BENEFITS Heart failure The now undisputed survival benefits of ACE inhibition were first demonstrated in the COoperative North Scandinavian ENalapril SUrvival Study (CONSENSUS) in 1987 (193). Patients with severe (New York Heart Association [NYHA] functional class IV) HF were randomized to treatment with either enalapril or placebo, and were followed up for 20 months. At this point, a striking reduction in mortality of 27% was apparent, mainly by reducing deaths from progressive HF. Subsequently, in the Studies Of Left Ventricular Dysfunction-treatment trial (SOLVD-T), enalapril was seen to reduce both mortality (194) and hospitalization for HF in patients with milder HF (NYHA II-III). After 12 years of follow-up, enalapril was still seen to confer a survival advantage, with median survival greater by 9 months over placebo (for patients in both treatment and prevention arms).
