Brief communication| Volume 84, ISSUE 3, SUPPLEMENT 1, 140-144, March 11, 1988

Effects of captopril on survival in patients with heart failure

      This paper is only available as a PDF. To read, Please Download here.


      Results from a large multicenter study and from the published literature suggest that captopril can improve survival in patients with advanced heart failure. The survival status of 105 patients with moderately severe heart failure who participated in a multicenter, double-blind comparison of captopril and placebo therapy was ascertained on an intention-to-treat basis. During the 90-day double-blind portion of this study, 21 percent (11 of 52 patients) of placebo-assigned patients died compared with four percent (two of 53 patients) of captopril-assigned patients (p <0.01). In addition, six previously published studies that provided comparative mortality data were identified. In one of these, the survival rate was reported to be improved in those who received captopril; in the other five studies, no conclusion could be drawn with respect to survival since death was an infrequent event within all treatment groups. Mechanisms by which captopril may improve survival include its favorable effects on hemodynamic parameters, its association with reduced ventricular ectopic activity, and its inhibitory effects on the renin-angiotensin and sympathetic nervous systems.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McKee PA
        • Castelli WP
        • McNamara PM
        • Kannel WB
        The natural history of congestive heart failure: the Framingham study.
        N Engl J Med. 1971; 285: 1441-1445
        • Cohn JN
        • Archibald DG
        • Ziesche S
        • et al.
        Effect of vasodilator therapy on mortality in chronic congestive heart failure.
        in: Results of a Veterans Administration cooperative study. N Engl J Med. 314. 1986: 1547-1552
        • CONSENSUS Trial Study Group
        Effects of enalapril on mortality in severe congestive heart failure.
        in: Results of the Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med. 316. 1987: 1429-1435
        • Kayanakis JG
        • Fauvel JM
        • Giraud P
        • Bounhoure JP
        Long-term treatment of congestive heart failure by captopril: hemodynamic, biological and clinical effects.
        Eur Heart J. 1981; 2: 75-81
        • Nakashima Y
        • Fouad FM
        • Tarazi RC
        Long-term captopril therapy in congestive heart failure: serial hemodynamic and echocardiographic changes.
        Am Heart J. 1982; 104: 827-833
        • Captopril Multicenter Research Group
        A placebo-controlled trial of captopril in refractory chronic congestive heart failure.
        J Am Coll Cardiol. 1983; 63: 755-763
        • Chatterjee K
        • Parmley WW
        • Cohn JN
        • et al.
        A cooperative multi-center study of captopril in congestive heart failure: hemodynamic effects and long-term response.
        Am Heart J. 1985; 110: 439-447
        • Awan NA
        • Mason DT
        Vasodilator therapy of severe congestive heart failure: the special importance of angiotensin-converting enzyme inhibition with captopril.
        Am Heart J. 1982; 104: 1127-1136
        • Fouad FM
        • Tarazi RC
        • Bravo EL
        • Hart NJ
        • Castle LW
        • Salcedo EE
        Long-term control of congestive heart failure with captopril.
        Am J Cardiol. 1982; 49: 1489-1496
        • Cleland J
        • Semple P
        • Hodsman P
        • Ball S
        • Ford I
        • Dargie H
        Angiotensin II levels, hemodynamics, and sympathoadrenal function after low-dose captopril in heart failure.
        Am J Med. 1984; 77: 880-886
        • Dennick LG
        • Maskin CS
        • Meyer JH
        • Schotz WE
        • Brown BW
        N Engl J Med. 1987; 317 ([letter to the editor]): 1350
        • Kaplan EL
        • Meier P
        Nonparametric estimation from incomplete observations.
        J Am Stat Assoc. 1958; 53: 457-481
        • Captopril-Digitalis Research Group
        Comparison of effects of captopril and digoxin on ejection fraction, exercise tolerance, clinical status, and arrhythmias in patients with mild to moderate heart failure.
        in: Proceedings of the 36th annual scientific session, American College of Cardiology. J Am Coll Cardiol. 9. 1987: 203A (abstr)
        • Lilly L
        • Dzau VJ
        • Williams GH
        • Hollenberg NK
        Captopril vs hydralazine in advanced congestive heart failure: comparison of one year survival.
        Circulation. 1985; 72 (abstr): III-408
        • Boccanelli A
        • Zachara E
        • Liberatore SM
        • Carboni GP
        • Prati PL
        Addition of captopril versus increasing diuretics in moderate but deteriorating heart failure: a double-blind comparative trial.
        Postgrad Med J. 1986; 62: 184-187
        • Packer M
        • Lee WH
        • Yushak M
        • Medina N
        Comparison of captopril and enalapril in patients with severe chronic heart failure.
        N Engl J Med. 1986; 315: 847-853
        • Magnani B
        • Magelli C
        Captopril in mild heart failure: preliminary observations of a long-term, double-blind, placebo-controlled multicenter trial.
        Postgrad Med J. 1986; 62: 153-158
        • Kleber FX
        • Laube A
        • Osterkorn K
        • Konig E
        Captopril in mild to moderate heart failure over 18 months; effects on morbidity and mortality.
        in: Proceedings of the 36th annual scientific session, American College of Cardiology. J Am Coll Cardiol. 9. 1987: 42A (abstr)
        • Packer M
        Prolonging life in patients with heart failure: the next frontier.
        Circulation. 1987; 75: IV 1-IV 3
        • Dargie HJ
        • Cleland JGF
        • Leckie BJ
        • Inglis CG
        • East BW
        • Ford I
        Relation of arrhythmias and electrolyte abnormalities to survival in patients with severe chronic heart failure.
        Circulation. 1987; 75: IV 98-IV 107
        • Packer M
        Sudden unexpected death in patients with congestive heart failure: a second frontier.
        Circulation. 1985; 72: 681-685
        • Cleland JGF
        • Dargie HJ
        • Robertson JIS
        • Ball SG
        • Hodsman GP
        The use of captopril in the management of cardiac failure.
        Scot Med J. 1984; 29: 129-130
        • Weinberger MH
        Influence of an angiotensin-converting enzyme inhibitor on diuretic-induced metabolic effects in hypertension.
        Hypertension. 1983; 5: III 132-III 138
        • Dzau VJ
        • Colucci WS
        • Hollenberg NK
        • Williams GH
        Relation of the renin-angiotensin-aldosterone system to clinical state in congestive heart failure.
        Circulation. 1981; 63: 645-651
        • Francis GS
        • Goldsmith SR
        • Olivari MT
        • Levine TB
        • Cohn JN
        The neurohumoral axis in congestive heart failure.
        Ann Intern Med. 1984; 101: 370-375
        • Packer M
        • Lee WH
        • Kessler PD
        • Gottlieb SS
        • Bernstein JL
        • Kukin ML
        Role of neurohumoral mechanisms in determining survival in patients with severe chronic heart failure.
        Circulation. 1987; 75: IV 80-IV 92
        • Franciosa JA
        Why patients with heart failure die: hemodynamic and functional determinants of survival.
        Circulation. 1987; 75: IV 20-IV 27
        • Lee WH
        • Packer M
        Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure.
        Circulation. 1986; 73: 257-267
        • Cohn JN
        • Levine TB
        • Olivari MT
        • et al.
        Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure.
        N Engl J Med. 1984; 311: 819-823
        • Ferrario CM
        • Dickinson CJ
        • McCubbin JW
        Central vasomotor stimulation by angiotensin.
        Clin Sci. 1970; 30: 239-245
        • Antonaccio MJ
        • Kerwin L
        Pre- and postjunctional inhibition of vascular sympathetic function by captopril in SHR.
        in: Implication of vascular angiotensin II in hypertension and antihypertensive actions of captopril. Hypertension. 3. 1981: I 54-I 62
        • Stein RD
        • Stephanson RB
        • Weaver LC
        Central actions of angiotensin II oppose baroreceptor-induced sympathoinhibition.
        Am J Physiol. 1984; 246: R13
        • Manthey J
        • Dietz R
        • Rohrig N
        • Schomig A
        Effects of hydralazine and captopril on sympathetic activity in patients with CHF.
        Eur Heart J. 1984; 5 (abstr): 50
        • Cleland JGF
        • Dargie HJ
        • Hodsman GP
        • et al.
        Captopril in heart failure.
        Br Heart J. 1984; 52: 530-535
        • Imai Y
        • Abe K
        • Seino M
        • et al.
        Captopril attenuates pressor responses to norepinephrine and vasopressin through depletion of endogenous angiotensin II.
        Am J Cardiol. 1982; 49: 1537-1539
        • Paterson JA
        • Naughton J
        • Peitras RJ
        • Gunnar RM
        Treadmill exercise in assessment of the functional capacity of patients with cardiac disease.
        Am J Cardiol. 1972; 30: 757-762