Abstract
The present study was performed in order to compare the efficacy, safety, and tolerability of lisinopril, a long-acting angiotensin-converting enzyme (ACE) inhibitor, with captopril, the shorter acting ACE inhibitor available, in the treatment of elderly patients (mean age 70 ± 0.5 years) with congestive heart failure (mean left ventricular ejection fraction 33.5 ± 1%). The study was organized according to a double-blind, parallel-group, randomized multicenter protocol. After a 14-day placebo run-in period, patients were randomized to receive either lisinopril 5 mg orally once per day or captopril 12.5 mg orally once per day. The dose of the study drug could be doubled at 2-week intervals for 6 weeks. The maximal dose was lisinopril 20 mg once per day or captopril 25 mg twice per day. The addition of either captopril or lisinopril to a regimen of diuretics caused a significant increase in exercise tolerance assessed by bicycle ergometry after 12 weeks of treatment (530 ± 21 seconds vs. 431 ± 13 seconds, p < 0.01; 555 ± 19 seconds vs. 463 ± 12 seconds, p < 0.01, respectively). Both drugs significantly increased left ventricular ejection fraction and stroke volume, were equally effective in improving NYHA class, and were well tolerated, with no differences detectable between treatments. The results of this study indicate that lisinopril 5–20 mg once daily is at least as effective and well tolerated as captopril 12.5–50 mg daily in the treatment of elderly patients with congestive heart failure.
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Kramer BL, Massie BM, Topie N. Controlled trial of captopril in chronic heart failure: A rest and exercise hemodynamic study. Circulation 1983;67:807-816.
Shape DN, Murphy J, Coxon R, Hannan SF. Enalapril in patients with chronic heart failure: A placebo-controlled randomized, double blind study. Circulation 1984;70:271-278.
Franciosa JA, Wilen MM, Jordan R. Effects of enalapril, a new angiotensin converting enzyme inhibitor, in controlled trial on heart failure. J Am Coll Cardiol 1985;5:101-107.
CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987;316:1429-1435.
Giles TD, Katz R, Sullivan JM, et al. Short-and long-acting angiotensin-converting enzyme inhibitor: A randomized trial of lisinopril versus captopril in the treatment of congestive heart failure. J Am Coll Cardiol 1989;13:1240-1247.
Bach R, Zardini P. Long-acting angitensin-converting enzyme inhibition: Once-daily lisinopril versus twice-daily captopril in mild to moderate heart failure. Am J Cardiol 1992;70:70C-77C.
Packer M, Lee WH, Yushak M, Medina N. Comparison of captopril and enalapril in patients with severe chronic heart failure. N Engl J Med 1986;315:847-853.
O'Neill CJA, Bowes SG, Sullens. Evaluation of the safety of the enalapril in the treatment of heart failure in the very old. Eur J Clin Pharmacol 1988;35:1143-1150.
Murphy PJ, Vander-Camen T, Malone-Lee J. Captopril in elderly patients with heart failure. Br Med J 1986;293:239-240.
O'Neil CJA, Charlett A, Dobbs RJ, et al. Effect of captopril on functional, physiological and biochemical outcome criteria in aged heart failure patients. Br J Clin Pharmacol 1992;33:167-178.
Lubsen J. Epidemiology of congestive heart failure. In: Van Zwietien PA, Mannin't Vedl AJ, Lie KL, eds. Heart Failure in Perspective. London: Royal Society of Medicine Services, 1990.
Folland ED, Parisi AF, Moghihan BS, et al. Assessment of left ventricular ejection fraction and volumes by real-time, two-dimensional echocardiography. Circulation 1979;60:760-771.
Captopril Multicenter Research Group. A placebo-controlled trial of captopril in refractory chronic congestive heart failure. J Am Coll Cardiol 1983;2:755-763.
Cleland JGF, Dargie HJ, Hodsman GP, et al. Captopril in heart failure: A double blind controlled trial. Br Heart J 1984;52:530-535.
Creager MA, Massie BM, Faxon DP, et al. Acute and long-term effects of enalapril on the cardivascular response to exercise and exercise tolerance in patients with congestive heart failure. J Am Coll Cardiol 1985;6:163-170.
Cleland JGF, Dargie HJ, Ball SG, et al. Effects of enalapril in heart failure: A double blind study of effects on exercise performance, renal function, hormones, and metabolic state. Br Heart J 1985;54:305-312.
Chalmers JP, West MJ, Cyran J, et al. Placebo-controlled study of lisinopril in congestive heart failure: A multicentre study. J Cardiovasc Pharmacol 1987;9(Suppl 3):S89-S97.
Likoff MJ, Chandler SL, Kay HR. Clinical determinants of mortality in chronic congestive heart failure secondary to idiopatic dilated or ischemic cardiomyopathy. Am J Cardiol 1987;59:634-638.
Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure: Results of a Veterans Administration cooperative study. N Engl J Med 1986;314:1547-1552.
Cohn JN, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine-isorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991;325:303-310.
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Morisco, C., Condorelli, M., Crepaldi, G. et al. Lisinopril in the Treatment of Congestive Heart Failure in Elderly Patients: Comparison versus Captopril. Cardiovasc Drugs Ther 11, 63–69 (1997). https://doi.org/10.1023/A:1007704024393
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DOI: https://doi.org/10.1023/A:1007704024393