Related Experiment Videos

Effect of certain angiotensin-converting enzyme inhibitors on mortality in heart failure: a multiple-propensity

Abhishek S Chitnis1, Rajender R Aparasu, Hua Chen

  • 1Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, 1441 Moursund St., Houston, TX, USA.

Research in Social & Administrative Pharmacy : RSAP
|April 23, 2011
PubMed

Insights

In heart failure (HF) patients, fosinopril and lisinopril significantly reduced mortality compared to captopril. This real-world study highlights potential differences in ACEI effectiveness for HF management.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Heart failure (HF) is a significant and increasing public health concern in the United States.
  • Angiotensin-converting enzyme inhibitors (ACEIs) are proven effective in HF, but comparative effectiveness of individual ACEIs remains unclear.

Purpose of the Study:

  • To evaluate the impact of individual ACEIs on mortality in a large, real-world patient population.
  • To compare the effectiveness of different ACEIs in managing heart failure outcomes.

Main Methods:

  • Retrospective analysis of a national cohort of Department of Veterans Affairs patients with HF.
  • Multiple-propensity score analysis to balance 47 baseline characteristics across different ACEI groups.
  • Propensity score-weighted Cox proportional hazard model used to assess time-to-death.

Main Results:

  • The study included 139,994 HF patients, with lisinopril (69.5%), fosinopril (21.8%), captopril (8.4%), and enalapril (0.3%) being the most common ACEIs.
  • Fosinopril (HR=0.739) and lisinopril (HR=0.818) were significantly associated with reduced mortality compared to captopril.
  • Enalapril showed similar mortality (HR=0.944) compared to captopril.

Conclusions:

  • Fosinopril and lisinopril demonstrated lower mortality rates in heart failure patients compared to captopril.
  • Results from this observational study require cautious interpretation and confirmation with HF severity data in future research.
Abstract

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors01:30

Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Antihypertensive Drugs: Direct Renin Inhibitors01:25

Antihypertensive Drugs: Direct Renin Inhibitors

The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...