Captopril treatment of chronic heart failure in the very old.

BACKGROUND

The safety and efficacy of angiotensin-converting enzyme inhibitors for very old patients with chronic heart failure have been less well documented than for younger patients.

METHODS

A prospective, randomized double-blind, placebo-controlled study of captopril, 25 mg twice daily, was designed. Fifty patients (mean age 84.2 +/- 5.2) participated. The degree of chronic heart failure (according to the Boston Study Group rating), the distance walked in 6 minutes, and the occurrence of uncontrolled heart failure and adverse reactions were used as main outcome measures.

RESULTS

Significantly more patients receiving placebo developed uncontrolled heart failure than patients receiving captopril (p = .022). In an intention to treat analysis, the first and last evaluations of the degree of chronic heart failure were compared. A significantly different evolution was observed between the two treatment groups (p < .001), with a significant improvement only in the captopril-treated patients (p < .001). The distance walked in 6 minutes improved significantly only in the captopril group (p = .004). The only adverse reaction was rash in two patients receiving captopril.

CONCLUSIONS

The study gives further evidence that angiotensin-converting enzyme inhibitor treatment for very old patients with chronic heart failure is useful.