PMID- 16507428
OWN - NLM
STAT- MEDLINE
DCOM- 20060620
LR  - 20131121
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 25
IP  - 3
DP  - 2006 Mar
TI  - Prevalence and prognostic significance of anemia in patients with congestive 
      heart failure treated with standard vs high doses of enalapril.
PG  - 333-8
AB  - BACKGROUND: Anemia is common in patients with congestive heart failure (CHF), 
      although its etiology and pathophysiology remain largely unexplained. The purpose 
      of this study was to examine the prognostic significance of a low hematocrit 
      (Hct) in patients with CHF and the possible role of angiotensin-converting enzyme 
      inhibition in anemia development. METHODS: Hct was measured at the time of 
      enrollment of 160 patients with CHF, mean age 56 +/- 12 years, in New York Heart 
      Association (NYHA) functional class 2.6 +/- 0.7 and with left ventricular 
      ejection fraction of 20 +/- 9%. They were randomized to standard (mean: 17.9 +/- 
      4.3 mg/day) or high (mean: 42 +/- 19.3 mg/day) doses of enalapril. The follow-up 
      duration was 2 years. Cox regression models were used to identify prognostic 
      factors, and correlations among individual variables were tested. RESULTS: Mean 
      baseline Hct was 42.7 +/- 5%. In multivariate analyses, low Hct (p = 0.036), 
      older age (p = 0.022) and low systolic blood pressure (p = 0.032) were 
      independent predictors of death within 2 years. A correlation was found between 
      baseline Hct and NYHA class (Spearman's correlation coefficient: -0.183, p = 
      0.008). A significant decrease in Hct from 43.2 +/- 4.9% at baseline to 40.7 +/- 
      4.4% at 2 years was observed in the group treated with high doses of enalapril (p 
      < 0.001). CONCLUSIONS: Low baseline Hct predicted poor 2-year prognosis in 
      patients with CHF. Enalapril administered in high doses increased the incidence 
      of anemia in this population. The underlying pathophysiologic mechanism and 
      effects of maintaining a normal Hct on clinical outcomes remain to be determined.
FAU - Terrovitis, John V
AU  - Terrovitis JV
AD  - Heart Science Centre Harefield Hospital, Harefield, Middlesex, UK.
FAU - Anastasiou-Nana, Maria I
AU  - Anastasiou-Nana MI
FAU - Alexopoulos, George P
AU  - Alexopoulos GP
FAU - Tsolakis, Elias J
AU  - Tsolakis EJ
FAU - Margari, Zafiria J
AU  - Margari ZJ
FAU - Drakos, Stavros G
AU  - Drakos SG
FAU - Tsagalou, Eleftheria P
AU  - Tsagalou EP
FAU - Papazoglou, Panagiotis
AU  - Papazoglou P
FAU - Efentakis, Stylianos
AU  - Efentakis S
FAU - Nanas, John N
AU  - Nanas JN
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20060106
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 69PN84IO1A (Enalapril)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anemia/*chemically induced/epidemiology
MH  - Enalapril/*administration & dosage/adverse effects
MH  - Female
MH  - Heart Failure/*complications/*drug therapy
MH  - Hematocrit
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prevalence
MH  - Prognosis
EDAT- 2006/03/02 09:00
MHDA- 2006/06/21 09:00
CRDT- 2006/03/02 09:00
PHST- 2005/06/02 00:00 [received]
PHST- 2005/09/16 00:00 [revised]
PHST- 2005/09/22 00:00 [accepted]
PHST- 2006/03/02 09:00 [pubmed]
PHST- 2006/06/21 09:00 [medline]
PHST- 2006/03/02 09:00 [entrez]
AID - S1053-2498(05)00746-1 [pii]
AID - 10.1016/j.healun.2005.09.019 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2006 Mar;25(3):333-8. doi: 10.1016/j.healun.2005.09.019. 
      Epub 2006 Jan 6.