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Abstract
In a double-blind study, 116 patients (mean age, 57.6 years) with mild-to-moderate
chronic congestive heart failure who were in sinus rhythm were randomly assigned to
receive 25 mg of captopril were daily (up to 50 mg twice daily, if needed) plus hydrochlorothiazide
(HCTZ) (group 1) or 0.1 mg of digoxin twice daily plus HCTZ (group 2) for 12 months.
During a 3-to 4-week pretreatment stabilization period, group 1 received a mean of
37.7 mg of HCTZ daily and group 2 received 34.9 mg daily. After 6 weeks and 12 months
of treatment, improvement was noted in both treatment groups on five measures of cardiac
function: exercise tolerance, left ventricular end-diastolic diameter (LVEDD), ejection
fraction, blood pressure, and heart rate. At 12 months, significantly greater improvement
was noted in group 1 than in group 2 in exercise tolerance (from 329 seconds at baseline
to 445 seconds at 12 months in group 1 and from 353 to 427 seconds in group 2; P < 0.05); LVEDD (from 60.5 to 56.5 mm in group 1 and from 60.3 to 57.9 mm in group
2; P < 0.05); and blood pressure (from 103.5 to 95.6 mm Hg in group 1 and from 101.9 to
97.0 mm Hg in group 2; P < 0.03). Clinical severity (New York Heart Association class) improved in both groups;
52% of the patients in group 1 and 41% in group 2 dropped an average of one functional
class (P < 0.01). The results indicate that captopril combined with a diuretic is an effective
initial treatment for patients with mild-to-moderate congestive heart failure.
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© 1995 Published by Elsevier Inc.
