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A Randomized, Double-Blinded Trial of Enalapril in Older Patients with Heart Failure and Preserved Ejection Fraction: Effects on Exercise Tolerance and Arterial Distensibility
Circulation: Heart Failure, 06/03/2010
Exclusive author commentary
Clinical Article
Kitzman DW et al. – In stable, compensated older HFPEF patients with controlled blood pressure, 12 months of enalapril did not improve exercise capacity or aortic distensibility. These data, combined with those from large clinical event trials, suggest that angiotensin inhibition does not substantially improve key long–term clinical outcomes in this group of patients.
Dalane W. Kitzman (06/04/2010) comments:
These findings contrast sharply with observations regarding the benefit of AII blockade in HF with reduced EF and highlight our incomplete understanding of this important and common disorder. This experience also highlights the importance of the multiple co-morbidities that are nearly uniformly present in older HF patients. This was observed not only in the present study of stable outpatients, but also in PEP-CHF and in I-PRESERVE. In the latter trial, 52% of the hospitalizations during follow-up were for non-cardiovascular causes. Optimal treatment of older HFPEF patients may need to take into account their multiple co-morbidities and non-cardiac events.