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Perindopril vs Enalapril in Patients with Systolic Heart Failure: Systematic Review and Metaanalysis

James J DiNicolantonio1, Tian Hu2, Carl J Lavie3

  • 1Department of Cardiology, Mid America Heart Institute, Saint Luke's Health System, Kansas City, MO.

Ochsner Journal
|September 25, 2014
PubMed

Insights

Perindopril significantly improves cardiac sympathetic nerve activity and heart failure markers compared to enalapril. When switched, perindopril also enhanced left ventricular ejection fraction in patients with systolic heart failure.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Angiotensin-converting enzyme (ACE) inhibitors are crucial for managing cardiovascular diseases.
  • Significant variations exist among ACE inhibitors regarding their pharmacokinetic and pharmacodynamic properties.
  • These differences may influence their efficacy in treating conditions like systolic heart failure.

Purpose of the Study:

  • To systematically review and meta-analyze the comparative effects of perindopril and enalapril.
  • To assess their impact on left ventricular function in patients diagnosed with systolic heart failure.

Main Methods:

  • A systematic review and meta-analysis was performed.
  • Studies comparing perindopril and enalapril in systolic heart failure patients were identified.
  • Searches were conducted across major scientific databases: MEDLINE, EMBASE, Web of Science, and Google Scholar.

Main Results:

  • Perindopril demonstrated significant improvements in cardiac sympathetic nerve activity compared to enalapril.
  • Key markers such as brain natriuretic peptide and New York Heart Association functional class were favorably impacted by perindopril.
  • While overall left ventricular ejection fraction did not show a significant difference, a notable improvement was observed when patients were switched from enalapril to perindopril at 6 months.

Conclusions:

  • Perindopril offers significant advantages over enalapril in improving cardiac sympathetic nerve activity, brain natriuretic peptide levels, and functional class in systolic heart failure.
  • Switching from enalapril to perindopril therapy can lead to a significant enhancement in left ventricular ejection fraction.
Abstract

Keywords:
Angiotensin-converting enzyme inhibitorscardiac outputenalaprilheart failure–systolicperindoprilsympathetic nervous system

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