The long-term efficacy and safety of ramipril, a long-acting angiotensin-converting enzyme inhibitor, were evaluated in 126 patients with moderate-to-severe congestive heart failure (New York Heart Association [NYHA] functional classes II to IV at baseline) in an open, multicenter trial lasting 96 weeks. An improvement in functional class, peripheral edema, and pulmonary congestion was evident after 2 weeks. At 12 weeks, improvement had reached a plateau, which was maintained throughout the 92 weeks of treatment; 89.3% of patients showed an improvement in NYHA class from baseline to endpoint. The improvements in peripheral edema and pulmonary congestion were statistically significant for change from baseline to endpoint ( P < 0.001, P < 0.0001, respectively; Bowker's symmetry test). Secondary variables of congestive heart failure, such as orthopnea and nocturnal dyspnea, also improved substantially. There were no significant changes in laboratory variables. Ramipril is an effective and well-tolerated therapy for the long-term treatment of patients with moderate-to-severe congestive heart failure.
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