A multicentre, double-blind, placebo-controlled trial of quinapril in mild, chronic heart failure

• Published in: European heart journal 1993-03, Vol.14 (3), p.403-409
• Main Authors: NORTHRIDGE, D. B., ROSE, E., RAFTERY, E. D., LAHIRI, A., ELDER, A. T., SHAW, T. R. D., HENDERSON, E., DARGIE, H. J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angiotensin converting enzyme inhibitor; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - pharmacology; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Cardiotonic agents; Cardiovascular system; Chronic Disease; chronic heart failure; Double-Blind Method; Drug Administration Schedule; Exercise Tolerance - drug effects; Female; Heart Failure - drug therapy; Humans; Isoquinolines - administration & dosage; Isoquinolines - pharmacology; Isoquinolines - therapeutic use; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Quality of Life; Quinapril; Stroke Volume - drug effects; Tetrahydroisoquinolines; Treatment Outcome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/14.3.403

Angiotensin converting enzyme (ACE) inhibitors are of proven value in patients with severe chronic heart failure (CHF). Studies of the effects of ACE inhibitors on exercise capacity and quality of life in mild CHF have produced conflicting results. We have studied the effects of quinapril, a new ACE inhibitor with a relatively short plasma half-life, in mild CHF. Once daily (o.d.) dosing was compared with twice daily (b.i.d.) dosing in a three-way cross-over, double-blind, placebo-controlled trial. Thirty-two patients (two female), mean age 59 (range 32–76) years were enrolled in three cardiology centres in the U.K. Twenty-seven patients were in NYHA Class II, five in Class III. The aetiology of heart failure was coronary artery disease in 29 patients, and non-ischaemic in three. The mean (range) radionuclide ejection fraction was 20.4% (8%–47%). Following full familiarization with the protocol, the treadmill exercise time (modified Bruce protocol) was determined for each patient during a placebo run-in phase, and at the end of each of three 8-week double-blind treatment phases with quinapril o.d., quinapril b.i.d. (maximal total daily dose 20 mg) and placebo. Three patients were withdrawn due to adverse events while receiving quinapril (unstable angina, exacerbation of CHF and arrhythmia); there were no deaths and no patient was withdrawn due to hypotension. Mean exercise time (the primary end-point) was 65 s and53 s longer in patients receiving quinapril o.d. and b.i.d. respectively compared to placebo (both P