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Type: Journal article
Title: Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus
Author: Ryden, L.
Armstrong, P.
Cleland, J.
Horowitz, J.
Massie, B.
Packer, M.
Poole-Wilson, P.
Citation: European Heart Journal, 2000; 21(23):1967-1978
Publisher: W B Saunders Co Ltd
Issue Date: 2000
ISSN: 0195-668X
Abstract: <h4>Aims</h4>An analysis was designed to determine whether chronic heart failure patients at high cardiovascular risk benefited to the same extent from high-dose lisinopril as the whole ATLAS population.<h4>Methods and results</h4>A retrospective analysis was performed on high-risk heart failure patients in the Assessment of Treatment with Lisinopril And Survival (ATLAS) trial (total number of patients 3164) comparing highdose (32.5-35 mg. day(-1)) vs low-dose (2.5-5 mg. day(-1)) lisinopril for a median of 46 months. These high-risk patients included those with hypotension, hyponatraemia, compromised renal function, the elderly and patients with diabetes mellitus at baseline. In the whole study population, high-dose lisinopril led to a trend in risk reduction of all-cause mortality (primary end-point P=0.128) and a significant risk reduction in all-cause mortality plus hospitalization (principal secondary end-point P=0.002). Subgroup analyses were performed for these end-points. There were no consistent interactions between age, baseline sodium, creatinine or potassium values, and treatment effect. Diabetics showed a beneficial response to high-dose therapy that was at least as good as that in non-diabetics. The underlying higher morbidity/mortality rates in diabetics mean that high-dose lisinopril has potential for a larger absolute clinical impact in these patients.<h4>Conclusion</h4>Long-term high-dose lisinopril was as effective and well-tolerated in high-risk patients, including those with diabetes mellitus, as for the ATLAS study population as a whole.
Keywords: Humans
Diabetes Complications
Chronic Disease
Angiotensin-Converting Enzyme Inhibitors
Drug Administration Schedule
Survival Analysis
Retrospective Studies
Databases, Factual
Aged, 80 and over
Middle Aged
New York
Heart Failure
Randomized Controlled Trials as Topic
DOI: 10.1053/euhj.2000.2311
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