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Drug proves ace at fighting heart failure.

A blood-vessel-dilating drug can prolong the survival of persons suffering from congestive heart failure, a chronic condition in which the heart's ability to pump is impaired, according to two independent groups of researchers. Their findings, announced this week, suggest such drug therapy may be able to prevent up to 20,000 deaths and 100,000 hospitalizations in the United States each year.

The new data confirm and extend earlier reports that angiotensin-converting-enzyme (ACE) inhibitors reduce the risk of early death for people with severe congestive heart failure. (ACE inhibitors belong to a group of drugs commonly used to treat hypertension by relaxing blood vessels.) The two new studies, detailed in the Aug. 1 New England Journal of Medicine, also demonstrate these drugs can benefit persons with mild to moderate heart failure.

Neither study applies to treatment of heart attack, in which the heart stops suddenly.

In one study, Salim Yusuf of the National Heart, Lung, and Blood Institute in Bethesda, Md., and investigators at 83 medical centers in the United States, Canada and Belgium randomly assigned 2,569 men and women with mild to moderate heart failure to daily treatment with either an ACE inhibitor (enalapril) or a placebo. Neither the patients nor the investigators knew which participants received enalapril. All volunteers continued to receive standard therapy for heart failure, such as the heart-strengthening drug digoxin.

Over a roughly 41-month treatment period, the researchers identified an 18 percent reduction in the risk of heart-related death for people taking the ACE inhibitor: Only 399 patients receiving enalapril died from heart failure, compared with 461 in the placebo group. The ACE inhibitor helped prevent the need for hospital visits as well. The team tallied 971 hospitalizations for heart failure in the placebo group - 42 percent more than among patients receiving enalapril.

In the second report, Jay N. Cohn of the University of Minnesota Medical School in Minneapolis and his colleagues present data suggesting that enalapril provides better protection for people with mild to moderate heart failure than a combination of hydralazine and isosorbide dinitrate, two other blood-vessel dilators.

Treating existing illness may offer only a partial victory in the battle against heart failure, these two groups of researchers agree. That's why Yusuf's team is now testing enalapril's ability to prevent chronic heart failure in people with some damage to the heart but not symptoms of long-term heart failure. Results of that trial are expected next year.
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Title Annotation:angiotensin-converting enzyme
Author:Fackelmann, Kathy A.
Publication:Science News
Date:Aug 3, 1991
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