Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study).

BACKGROUND: In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database. METHODS: The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20-80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction < or =30% or cardiothoracic index > or =60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors. RESULTS: Duration of disease >1 year, renal failure, serum sodium > or =138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival. CONCLUSION: Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure.

[Duration of action of trandolapril in mild to moderate hypertensive patients evaluated by ambulatory measurement of blood pressure]. / Durée d'action du trandolapril chez l'hypertendu léger á modéré, évaluée par mesure ambulatoire de la pression artérielle.

The duration of the antihypertensive action of transdolapril, a new angiotensin converting enzyme inhibitor, was studied in 23 patients using ambulatory blood pressure monitoring (ABPM) over 48 hours. After a 20-day placebo period (D1 to D20), mild to moderate hypertensive patients received 2 mg trandolapril once daily for 30 days (D21 to D50). The first 24-hour ABPM recording was performed on day 14, during the placebo run-in period. Two additional recordings were done successively on days 50 and 51 corresponding to a normal dosing day and a following day with a simulated missed dose, respectively. The three blood pressure recordings (placebo, treatment, missed dose) were compared. The average 24-hour systolic (SBP) and diastolic (DBP) blood pressure were significantly decreased by trandolapril. The mean +/- s.d. decrease between day 14 and day 50 were - 8.0 +/- 7.2 mmHg for the DBP and -13.3 +/- 7.8 mmHg for the SBP. Blood pressure was also consistently decreased during the daytime period (-8.7 +/- 7.9 mmHg for the DBP and - 15.6 +/- 8.5 mmHg for the SBP), nighttime period (-5.6 +/- 9.1 mmHg for the DBP and - 8.5 +/- 11.3 mmHg for the SBP) and early morning (- 12.3 +/- 9.7 mmHg for the DBP and - 15.9 +/- 15.1 mmHg for the SBP). The normal circadian pattern of blood pressure was maintained under treatment. The antihypertensive effect of trandolapril was sustained beyond 24 hours after the last intake: there were no significant difference beetween days 50 and 51 in terms of 24-hour, daytime and nighttime average blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)