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  • High dose lisinopril was more effective than low dose for reducing combined mortality and cardiovascular events in congestive heart failure

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Therapeutics
High dose lisinopril was more effective than low dose for reducing combined mortality and cardiovascular events in congestive heart failure

https://doi.org/10.1136/ebm.5.4.110

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    (1999) Circulation 100, 2312. Packer M, Poole-Wilson PA, Armstrong PW. , et al, on behalf of the ATLAS Study Group. . Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure.. Dec 7;. :. –8..
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 QUESTION: In patients with congestive heart failure (CHF), is high dose lisinopril more effective than low dose lisinopril for reducing mortality and admission to hospital rates?

    Design

    Randomised (allocation concealment unclear*), blinded (patients, investigators, and outcome assessors),* controlled trial with 3 year follow up.

    Setting

    287 hospitals in 19 countries.

    Patients

    3793 patients were screened, and 3164 (mean age 63.6 y, 80% men) were studied. Inclusion criteria were New York Heart Association class II, III, or IV CHF, despite use of diuretics for ≥2 months, and left ventricular ejection fraction ≤30%. Exclusion criteria were recent revascularisation procedure or ischaemic event, history of ventricular tachycardia, intolerance to angiotensin converting enzyme (ACE) inhibitors, serum creatinine levels >2.5 mg/dl, or non-cardiac disorders that could limit survival. Follow up was 100%.

    Intervention

    Patients received their usual CHF medications …

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    Footnotes

    • Source of funding: Zeneca Pharmaceuticals.

    • For correspondence: Dr M Packer, Division of Circulatory Physiology, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA. Fax+1 212 305 7439.

    • ↵* See glossary.