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Lisinopril in the treatment of congestive heart failure
1Tulane University School of Medicine, Veterans Administration Medical Center, New Orleans, Louisiana.
Insights
Lisinopril effectively treats congestive heart failure (CHF), improving exercise capacity and heart function. This ACE inhibitor is well-tolerated and beneficial, even in patients with renal impairment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) is a significant clinical condition requiring effective treatment.
- Angiotensin-converting enzyme (ACE) inhibitors are a cornerstone therapy for CHF.
Purpose of the Study:
- To evaluate the efficacy and tolerability of lisinopril, a novel ACE inhibitor, in patients with CHF.
- To compare lisinopril with placebo and captopril in managing CHF symptoms and improving cardiac function.
Main Methods:
- Prospective, randomized, double-blind trials were conducted.
- Patients with NYHA Class II-IV CHF received lisinopril, placebo, or captopril, alongside digitalis and diuretics.
Main Results:
- Lisinopril significantly improved exercise duration, left ventricular ejection fraction (LVEF), and CHF symptoms compared to placebo.
- Lisinopril demonstrated efficacy in patients with renal impairment, unlike captopril, and improved LVEF.
- Both drugs were well-tolerated, with lisinopril showing similar tolerability to captopril.
Conclusions:
- Lisinopril is an effective and well-tolerated treatment option for congestive heart failure.
- Lisinopril offers advantages over captopril, particularly in patients with renal impairment.
- Lisinopril represents a valuable addition to the therapeutic arsenal for managing CHF.
Abstract:
In a series of studies, lisinopril, a new, once-daily, non-sulphydryl-containing ACE inhibitor, has been evaluated for the treatment of congestive heart failure (CHF). Lisinopril significantly improved exercise duration, left ventricular ejection fraction (LVEF) and the clinical signs and symptoms of CHF when compared with placebo in a 12-week prospective, randomised, double-blind trial involving 130 patients (NYHA Class II-IV) who were also receiving digitalis and diuretics. In another study involving 10 patients with CHF, lisinopril was found to increase maximal oxygen uptake. Lisinopril has also been compared with captopril in a 12-week randomised, double-blind, parallel trial in 189 patients with CHF (Class II-IV) on digoxin and diuretics. Both lisinopril and captopril increased treadmill exercise times. However, lisinopril was equally effective in patients with renal impairment whereas captopril was not. Also, lisinopril, but not captopril, improved LVEF. In all studies, lisinopril was well tolerated in a manner similar to captopril. Lisinopril produces more frequent increases in serum creatinine than captopril, but these changes are rarely of significant consequence. These results confirm those of previous studies, from which it is concluded that lisinopril is an important addition to the ACE inhibitor class for the treatment of CHF.