Treatment with verapamil and trandolapril in patients with congestive heart failure and myocardial infarction

EFFECTS OF VERAPAMIL AND TRANDOLAPRILProgression of heart failure, sudden death and death from re-infarction are the major causes of the increased mortality in postinfarct patients with congestive heart failure. Angiotensin converting enzyme (ACE) inhibitors such as trandolapril can prevent the progression of heart failure and thus improve survival. The calcium antagonist verapamil has been shown to prevent sudden death and re-infarction in postinfarct patients without congestive heart failure. HYPOTHESISThe Danish Verapamil Infarction Trial (DAVIT) study group hypothesized that combined treatment with trandolapril and verapamil might prevent cardiac events in postinfarct patients with coronary heart disease. The first double-blind randomized trial included 100 patients and supported this hypothesis, as the cardiac event rate was significantly lower after 3 months in patients treated with the combination than in those treated with trandolapril alone (14 versus 35%, respectively; P = 0.01, hazard ratio 0.35, 95% confidence interval 0.15–0.85).