[Treatment of cardiac failure with enalapril].

The fall in cardiac output observed in cardiac failure induces stimulation of the renin-angiotensin-aldosterone system. This results in strong constriction of the arterioles which in turn increases the fall in cardiac output and aggravates myocardial alteration. Angiotensin-converting enzyme inhibitors therefore act on a major physiological mechanism of cardiac failure. In this double-blind study 36 cardiac failure patients treated with digitalis derivatives and diuretics were divided into two groups: one group received enalapril in addition to the other drugs, the other group received a placebo. The functional symptoms, exercise tests, left ventricular function and haemodynamic values were improved in two-thirds of the patients treated with enalapril, whereas no improvement was observed in those who received the placebo. Enalapril maleate was given by injection to 10 patients with acute left ventricular failure following myocardial infarction; a useful fall in pulmonary capillary pressure and systemic arterial resistance occurred within one hour. Enalapril represents an effective physiopathological treatment of severe cardiac failure.