enalapril and Fatigue

In the Studies of Left Ventricular Dysfunction (LVD), enalapril or placebo was administered in a double-blind fashion to 6797 participants with ejection fraction < or = 0.35. During 40 months' average follow-up, 28.1% of participants randomized to enalapril reported side effects compared with 16.0% in the placebo group (p < 0.0001). Enalapril use was associated with a higher rate of symptoms related to hypotension (14.8% vs 7.1%, p < 0.0001), azotemia (3.8% vs 1.6%, p < 0.0001), cough (5.0% vs 2.0%, p < 0.0001), fatigue (5.8% vs 3.5%, p < 0.0001), hyperkalemia (1.2% vs 0.4%, p = 0.0002), and angioedema (0.4% vs 0.1%, p < 0.05). Side effects resulted in discontinuation of blinded therapy in 15.2% of the enalapril group compared with 8.6% in the placebo group (p < 0.0001). Thus enalapril is well tolerated by patients with LVD; however, hypotension, azotemia, cough, fatigue, and other side effects result in discontinuation of therapy in a significant minority of patients.

Topics: Aged; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Cough; Double-Blind Method; Enalapril; Fatigue; Female; Follow-Up Studies; Heart Failure; Humans; Hyperkalemia; Hypotension; Male; Middle Aged; Sex Factors; Time Factors; Uremia; Ventricular Dysfunction, Left

A multicenter, randomized, double-blind assessment of 130 patients with congestive heart failure (New York Heart Association functional classes II to IV) was undertaken to assess the therapeutic efficacy of lisinopril, an angiotensin-converting enzyme inhibitor. All the subjects received concurrent therapy with digoxin and diuretics. Assessments performed periodically over 12 weeks revealed that the active treatment was associated with significant improvements in treadmill exercise time, cardiothoracic ratio, ejection fraction, functional status and clinical signs and symptoms of heart failure. Lisinopril exhibited a mild first-dose effect on blood pressure that was not significantly different from that observed with placebo. The incidence of adverse experiences was not markedly different in the 2 study groups, with only mild hypotension and dizziness occurring more frequently in association with the active medication.

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Cardiac Output; Clinical Trials as Topic; Double-Blind Method; Dyspnea; Enalapril; Exercise Test; Fatigue; Heart Failure; Humans; Lisinopril; Multicenter Studies as Topic; Placebos; Random Allocation; Time Factors

Topics: Antihypertensive Agents; Enalapril; Fatigue; Humans; Hypertension; Male; Middle Aged; Periodicity; Snoring

Topics: Cardiac Output, Low; Enalapril; Fatigue; Humans; Ventricular Dysfunction, Left

A new clinical index of dyspnea and fatigue has been applied to rate the condition of patients with congestive heart failure. The index has 3 components, each rated on a scale from 0 to 4, for the magnitude of the task that evokes dyspnea or fatigue, the magnitude of the pace (or effort) with which the task is performed and the associated functional impairment in general activities. The ratings for each component are added to form an aggregated score, which can range from 0, for the worst condition, to 12, for the best. Because dyspnea and fatigue are prime symptoms and sources of clinical distress, the index helps reflect the quality of life in patients with congestive heart failure. In double-blind trials of therapy, changes in the index showed good correlations with patients' self-selected ratings of improvement. The posttherapeutic changes in the index ratings were significantly higher with a new active agent (lisinopril) than with placebo or another active agent (captopril).

Topics: Angiotensin-Converting Enzyme Inhibitors; Captopril; Double-Blind Method; Dyspnea; Enalapril; Fatigue; Heart Failure; Humans; Lisinopril; Quality of Life; Random Allocation