Enalapril: a review of quality-of-life and pharmacoeconomic aspects of its use in heart failure and mild to moderate hypertension.

Enalapril is an angiotensin converting enzyme (ACE) inhibitor with an established clinical profile. In patients with symptomatic heart failure, enalapril reduces overall mortality, death from progressive heart failure and hospitalisation rates. In those with asymptomatic left ventricular dysfunction, enalapril decreases the combined risk of death and development of heart failure, and the risk of death and hospitalisation. The effects of enalapril in reducing hospitalisation rates in symptomatic patients translate into net savings in healthcare costs in heart failure. Enalapril also produces modest benefits in quality-of-life (QOL) parameters in patients with symptomatic heart failure as shown in well controlled studies. Its effects appear similar to those of hydralazine plus isosorbide dinitrate. The influence of enalapril on quality of life in patients with asymptomatic disease is minimal but not deleterious. Enalapril generally either maintains or slightly improves quality of life from baseline in patients with mild to moderate hypertension. The drug appears to have a QOL profile that is more favourable than that of propranolol and similar to those of most other comparator drugs, as assessed by subjective measures of quality of life. Clarification is required of its QOL profile relative to that of captopril, in view of conflicting results in the literature. The effects of enalapril on cognitive and psychomotor function appear to resemble those of comparator agents. Thus, enalapril has modest beneficial effects on the quality of life of patients with symptomatic heart failure, while generally maintaining quality of life in patients with asymptomatic left ventricular dysfunction or mild to moderate hypertension. Enalapril is a cost-effective treatment in heart failure that would be expected to yield considerable cost savings in this therapeutic area.