Clinical Trials And Observational Studies

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The efficacy of ACE-I has been widely evaluated in clinical trials and observational studies. In 1983, Captopril multicenter research group investigated the efficacy of Captopril in a 92 cohort with heart failure refractory to digitalis and diuretic therapy. In this randomized, double blind trial, 50 patients were assigned to Captopril and 42 were assigned to placebo group. Over 2-week dosage titration and 10-week evaluation period, the Captopril group revealed improvement in exercise tolerance and specific symptoms of heart failure, including dyspnea, fatigue and orthopnea, and the reduction of edema. Captopril therapy were concluded as an effect adjunctive treatment to digitalis and diuretic drugs for patients with refractory heart failure. (14) Later on, other ACE-I, such as Enalapril, were shown to be effective in treating patients with congestive heart failure, by reducing left ventricular dimension, in randomized clinical studies.(15-17) The Heart Outcomes Prevention Evaluation Study Investigators conducted a factorial study to evaluate the ACE-I, Ramipril, for improving outcomes among patients with high risk for cardiovascular events, but without left ventricular dysfunction or heart failure. Ramipril significantly reduced the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have heart failure. (18) Cattran et al. performed a registry study in Toronto Glomerulonephritis in patients with severe immunoglobulin
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