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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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 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?


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


287 hospitals in 19 countries.


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%.


Patients received their usual CHF medications …

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  • 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.