From the Guidelines
Enalapril, an ACE inhibitor, is primarily used to reduce morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF).
Key Uses of Enalapril
- Heart Failure with Reduced Ejection Fraction (HFrEF): Enalapril is used to reduce the risk of death and hospitalization in patients with HFrEF, regardless of the severity of symptoms or the presence of coronary artery disease 1, 2, 3.
- Hypertension: Although not explicitly mentioned in the provided evidence, ACE inhibitors like Enalapril are commonly used to treat hypertension, as they help to relax blood vessels and reduce blood pressure.
Important Considerations
- Contraindications: Enalapril should not be given to patients who have experienced life-threatening adverse reactions, such as angioedema, or to those who are pregnant or plan to become pregnant 3.
- Caution: Enalapril should be used with caution in patients with low systemic blood pressure, renal insufficiency, or elevated serum potassium levels 1, 2, 3.
- Dosing: Enalapril should be started at low doses and titrated upward to doses shown to reduce the risk of cardiovascular events in clinical trials 1, 2, 3.
Comparison with Other Agents
- Angiotensin Receptor Blockers (ARBs): ARBs are recommended for patients with HFrEF who are intolerant to ACE inhibitors due to cough or angioedema 1, 2.
- Angiotensin Receptor-Neprilysin Inhibitors (ARNIs): ARNIs have been shown to be superior to ACE inhibitors in reducing morbidity and mortality in patients with HFrEF, but their use is associated with a higher risk of hypotension and renal insufficiency 1, 2.
From the FDA Drug Label
Enalapril maleate is indicated for the treatment of hypertension. Enalapril maleate is effective alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. Enalapril maleate is indicated for the treatment of symptomatic congestive heart failure, usually in combination with diuretics and digitalis. Enalapril maleate decreases the rate of development of overt heart failure and decreases the incidence of hospitalization for heart failure in clinically stable asymptomatic patients with left ventricular dysfunction.
Enalapril (ACE inhibitor) is used for:
- Hypertension: to lower blood pressure
- Symptomatic congestive heart failure: to improve symptoms, increase survival, and decrease hospitalization
- Asymptomatic left ventricular dysfunction: to decrease the rate of development of overt heart failure and hospitalization for heart failure 4
From the Research
Uses of Enalapril
- Enalapril is used to treat hypertension, including essential and renovascular hypertension, by decreasing blood pressure without increasing heart rate or output 5, 6, 7.
- It is also used to treat congestive heart failure, providing significant haemodynamic, symptomatic, and clinical improvement, and reducing mortality in patients with severe heart failure 8, 6, 7.
- Enalapril may be used as a first-line therapeutic option for hypertension and as an adjuvant therapy for congestive heart failure 5, 8.
- Additionally, ACE inhibitors like enalapril are being studied for their potential to decrease left ventricular size after infarction and to slow the rate of internal hyperplasia 6.
Administration and Pharmacology
- Enalapril is usually administered orally once daily and is well absorbed after oral administration, with peak serum concentrations occurring 4 hours after a dose 7.
- It is hydrolyzed to its bioactive form, enalaprilic acid, and has a serum half-life of approximately 35 hours, with steady state achieved by the fourth day of treatment 7.
- Enalapril controls blood pressure without affecting heart rate or cardiovascular reflexes, and decreases serum concentrations of ACE, angiotensin II, and aldosterone, while increasing plasma renin activity 7.
Safety and Tolerability
- Enalapril is generally safe and well tolerated, with the most frequent adverse effect being cough, which can limit therapy 5.
- Human experience indicates that enalapril is safe and well tolerated, although its use during pregnancy is associated with specific fetal and neonatal injury, known as "ACEI fetopathy" 9.