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Comparative Effects of Therapy With Captopril and Digoxin in Patients With Mild to Moderate Heart Failure

Jay Cohn, MD; Morton Hawkins, ScD; Herbert Levine, MD; John Naughton, MD; Elliot Rapaport, MD; Sidney Goldstein, MD; Bertram Pitt, MD; Robert Cody, MD; Prakash Deedwania, MD; Leonard Dennick, MD; Joseph Franciosa, MD; Mark McGovern, MD; Joseph Meyer, PhD; Alan Gradman, MD; Barry Massie, MD; Milton Packer, MD; James Doherty, MD; Jacquelyn Gammill; William Cooper, MS; Stanford Engel, PhD; Rita Fand, MPH; Barbara Hallows; Linda Kerwin, MS; Debra A. Soltesz; John O. Parker, MD; Karen Lahey, RN; Prakash C. Deedwania, MD; Enrique Carbajal, MD; Pat Watson, RN; Robert DiBianco, MD; James A. Ronan, MD; Dennis J. Donohue, MD; Keith M. Lindgren, MD; Louis J. Larca, MD; Judy Freitag, RN; Donna Lindemuth, RN; Jeffrey B. Lakier, MD; Howard S. Rosman, MD; Mary Beth Wlodkowski, RN; Robert J. Cody, MD; Spencer H. Kubo, MD; Mary Clark, RN; Katie Pondolfino, RN; Joseph A. Franciosa, MD; Mary Wilen, RN; Drexel Jordan, RN; Sunil K. Das, MD; John M. Nicklas, MD; Mary Kay Foley, RN; Michael B. Higginbotham, MD; Frederick R. Cobb, MD; Jean Wilson, RN; David M. Berkson, MD; Dragic Obradovic, MD; Patricia Hershinow, RN; N. Gary Nicholls, MD; Hamid Ikram, MD; Ian Crozier, MD; Carl J. Pepine, MD; John Culp, MD; Marion Limacher, MD; Kathy Mulvehill-Verbust, RN; D. John Farnham, MD; Dorothy Adams; Norene Streicher, RN; Carol Shanley, RN; Mark A. Greenberg, MD; Janet Strain, MD; Mary Hewitt, PA-C; Barbara Levine, PA-C; D. Norman Sharpe, MD; Robin Briant, MD; Rene Coxon, RN; Barry M. Massie, MD; James W. Cornyn, MD; Nina Topic, RN; Harold Willens, MD; Denise Antonishen, RN; Dorothy Reinstein, RN; Harry Colfer, MD; Karen E. Graham, RN; Gerald M. Perlow, MD; Harvey S. Zarren, MD; Barbara Bent, RN; Marjorie Zicherman, RN; Barry Zaret, MD; Deborah Lawrason, PA; Pat Tellier, RN; Kathy O'Keefe, RN; Syed Mohiuddin, MD; Lois Stengel, RN; James D. Madison, MD; Nancy Carruthers, RN; Fernando Elijovich, MD; Mary O'Sullivan, RN; Uri Elkayam, MD; Shabudin H. Rahimtoola, MB, FRCP; Laura Weber, RN; Sheldon Gottlieb, MD; Carol Brown, RN; Mariell D. Jessup, MD; Susan Ulrich, RN; Jane Kronenthal, RN; Denise Capaccio; Colin Grant, MD; Edward Gillie, MD; Pat Wood, RN; Fetnat M. Fouad-Tarazi, MD; Kay Petey, RN
JAMA. 1988;259(4):539-544. doi:10.1001/jama.1988.03720040031022.
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This multicenter, double-blind, placebo-controlled study compares the effects of captopril treatment with those of digoxin treatment during maintenance diuretic therapy in patients with mild to moderate heart failure. Compared with placebo, captopril therapy resulted in significantly improved exercise time (mean increase, 82 s vs 35 s) and improved New York Heart Association class (41% vs 22%), but digoxin therapy did not. Digoxin treatment increased ejection fraction (4.4% increase) compared with captopril therapy (1.8% increase) and placebo (0.9% increase). The number of ventricular premature beats decreased 45% in the captopril group and increased 4% in the digoxin group in patients with more than ten ventricular premature beats per hour. Treatment failures, increased requirements for diuretic therapy, and hospitalizations were significantly more frequent in patients receiving placebo compared with those receiving either active drug. Transitory hypotension occurred more frequently with administration of captopril. Captopril treatment is significantly more effective than placebo and is an alternative to digoxin therapy in patients with mild to moderate heart failure who are receiving diuretic maintenance therapy.

(JAMA 1988;259:539-544)


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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