PMID- 1820294
OWN - NLM
STAT- MEDLINE
DCOM- 19920804
LR  - 20140729
IS  - 0340-9937 (Print)
IS  - 0340-9937 (Linking)
VI  - 16 Spec No 1
DP  - 1991 Sep
TI  - [Prognosis of mild chronic heart failure: effects of the ACE inhibitor 
      captopril].
PG  - 283-93
AB  - The Munich Mild Heart Failure Trial (MHFT) investigated the influences of 
      ACE-inhibition on progression of congestive heart failure (CHF). Major end points 
      were progression of CHF from New York Heart Association (NYHA) functional classes 
      I to III to NYHA functional class IV despite optimal adjusted standard therapy 
      and death due to congestive heart failure, i.e. death due to pump failure or 
      sudden death. 170 patients were randomly assigned to treatment with either 
      captopril (n = 83) 25 mg b.i.d. or placebo in addition to standard therapy for a 
      median observation period of 2.7 years. The major result of this trial was the 
      decrease in the relative risk for progressive heart failure by captopril therapy 
      to 34% (95% confidence interval 17 to 68%; p = 0.01). Though total mortality was 
      not reduced, death due to pump failure was found considerably less often on 
      captopril than on placebo (18.2 vs 50% of total deaths in each group). In 
      addition this report describes influences of captopril therapy on left 
      ventricular size and function, heart size on X-ray, influences on symptomatology, 
      electrolytes, ventricular arrhythmias, on concomitant therapy as well as effects 
      in various subgroups. The major finding of the trial--the influence on 
      progression of CHF--was independent of the underlying cardiac disease and was 
      consistent in subgroups with different etiology of heart failure. Captopril 
      blunted the increase in norepinephrine levels usually seen with increasing 
      severity of congestive heart failure. There was a significant increase in serum 
      sodium and potassium levels in the captopril treated group. Left ventricular size 
      and function were well preserved in the patients still on randomized therapy 
      after two years. No effects of therapy on ventricular ectopic activity were found 
      in a subgroup of 93 patients that had had Holter monitoring. IN CONCLUSION: 
      Captopril has marked effects on progression of disease and reduces the likelihood 
      of progressive heart failure in patients with mild symptoms. Several indices of 
      unfavourable prognosis are either improved (sodium, norepinephrine, angiotensin 
      II) or stabilized (left ventricular function). Thus ACE-inhibitors are to be 
      considered for all patients requiring medical therapy for congestive heart 
      failure.
FAU - Kleber, F X
AU  - Kleber FX
AD  - Abteilung fur Kardiologie, Krankenhaus Munchen-Schwabing, Akademisches 
      Lehrkrankenhaus, der Ludwig-Maximilians-Universitat Munchen.
FAU - Doering, W
AU  - Doering W
LA  - ger
PT  - Clinical Trial
PT  - English Abstract
PT  - Journal Article
PT  - Randomized Controlled Trial
TT  - Prognose bei leichter chronischer Herzinsuffizienz: Einflusse des ACE-Hemmers 
      Captopril.
PL  - Germany
TA  - Herz
JT  - Herz
JID - 7801231
RN  - 9G64RSX1XD (Captopril)
RN  - RWP5GA015D (Potassium)
RN  - X4W3ENH1CV (Norepinephrine)
RN  - YKH834O4BH (Epinephrine)
SB  - IM
MH  - Captopril/*therapeutic use
MH  - Cause of Death
MH  - Chronic Disease
MH  - Death, Sudden, Cardiac/prevention & control
MH  - Double-Blind Method
MH  - Epinephrine/blood
MH  - Heart Failure/*drug therapy/mortality/physiopathology
MH  - Hemodynamics/*drug effects/physiology
MH  - Humans
MH  - Norepinephrine/blood
MH  - Potassium/blood
MH  - Survival Rate
MH  - Ventricular Function, Left/drug effects/physiology
EDAT- 1991/09/01 00:00
MHDA- 1991/09/01 00:01
CRDT- 1991/09/01 00:00
PHST- 1991/09/01 00:00 [pubmed]
PHST- 1991/09/01 00:01 [medline]
PHST- 1991/09/01 00:00 [entrez]
PST - ppublish
SO  - Herz. 1991 Sep;16 Spec No 1:283-93.