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Comparative Effects of Therapy With Captopril and Digoxin in Patients With Mild to Moderate Heart Failure
The Captopril-Digoxin Multicenter Research Group;
Jay Cohn, MD;
Morton Hawkins, ScD;
Herbert Levine, MD;
John Naughton, MD;
Elliot Rapaport, MD;
Sidney Goldstein, MD;
Bertram Pitt, MD;
Sidney Goldstein, MD;
Robert Cody, MD;
Prakash Deedwania, MD;
Leonard Dennick, MD;
Joseph Franciosa, MD;
Mark McGovern, MD;
Joseph Meyer, PhD;
Bertram Pitt, MD;
Joseph Franciosa, MD;
Sidney Goldstein, MD;
Robert Cody, MD;
Prakash Deedwania, MD;
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;
Alan Gradman, MD;
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;
Milton Packer, MD;
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.
Abstract
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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)
Author Affiliations
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Policy and Data Monitoring Board; Cochairmen, Committee of Investigators; Editorial Committee; Core Exercise Laboratory; Ambulatory ECG Committee; Ambulatory ECG Core Laboratory Medical Monitors Inc, Barbara Resnick, coordinator; Core Digoxin Assay Laboratory; Coordinating Center; Clinical Centers Queen's University, Kingston, Ontario; Veterans Administration Medical Center, Fresno, Calif; Washington Adventist Hospital, Takoma Park, Md; Henry Ford Hospital, Detroit; New York Hospital/Cornell Medical Center, New York; University of Arkansas for Medical Sciences, Little Rock; University of Michigan Medical Center, Ann Arbor; Durham (North Carolina) Veterans Administration Medical Center; St Joseph's Hospital, Chicago; Princess Margaret Hospital, Christchurch, New Zealand; University of Florida, Gainesville; Jackson Clinic, Madison, Wis; Montefiore Hospital, Bronx, New York; Auckland Hospital, Grafton, New Zealand; Veterans Administration Medical Center, San Francisco; Sinai Hospital of Detroit; Burns Clinic, Petoskey, Mich; Gerald M. Perlow and Associates, Lynn, Mass; Yale University School of Medicine, New Haven, Conn; St Joseph Hospital (Creighton University Cardiac Center), Omaha; St Paul—Ramsey Medical Center; Mount Sinai Hospital, New York; University of Southern California Medical School, Los Angeles; Francis Scott Key Hospital, Baltimore; Hahnemann University, Philadelphia; Veterans Administration Hospital, Manchester, NH; Cleveland Clinic
From the Captoril-Digoxin Multicenter Research Group.
Footnotes
Reprint requests to Division of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202 (Sidney Goldstein, MD).
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