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[Lisinopril in the treatment of heart insufficiency]
C Barcina Sánchez1, M Martín Cortés, A Fernández Fernández
1Zeneca Farma, S.A. Departamento Médico, Madrid.
Insights
Angiotensin converting enzyme (ACE) inhibitors, like lisinopril, improve heart failure outcomes. Lisinopril is effective compared to placebo and other ACE inhibitors, offering a well-tolerated treatment option.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure (HF) carries a poor prognosis.
- Angiotensin converting enzyme (ACE) inhibitors offer significant benefits in HF management, including improved hemodynamics, clinical status, and mortality.
- Lisinopril is a once-daily ACE inhibitor evaluated for HF treatment.
Purpose of the Study:
- To review data comparing lisinopril with other ACE inhibitors (captopril, enalapril) and digoxin in heart failure patients.
- To assess lisinopril's efficacy and tolerability in various heart failure treatment regimens.
- To explore potential mechanisms of ACE inhibitor benefit beyond renin-angiotensin-aldosterone system (RAAS) blockade.
Main Methods:
- Review of comparative studies involving lisinopril, captopril, enalapril, and digoxin in heart failure patients.
- Evaluation of hemodynamic parameters, exercise test results, and clinical symptoms.
- Analysis of patient data from studies where diuretics and/or digoxin were co-administered.
Main Results:
- Lisinopril demonstrated greater efficacy than placebo and was at least as effective as captopril or enalapril in improving hemodynamic and clinical outcomes in HF.
- Lisinopril showed potential as an alternative or adjunct to digoxin in patients on diuretics alone.
- Lisinopril was generally well tolerated in heart failure patients.
Conclusions:
- Lisinopril is an effective and well-tolerated ACE inhibitor for heart failure management.
- Further research, such as the ATLAS study, is investigating optimal dosing strategies for ACE inhibitors in general practice.
- Mechanisms of ACE inhibitor benefit may include RAAS blockade, sympathetic modulation, cardioreparation, and potassium balance regulation.
Abstract:
The prognosis in patients with heart failure (HF) is poor. The angiotensin converting enzyme (ACE) inhibitors are among the most promising of current options, with benefits not only in terms of haemodynamic and clinical improvement but also in mortality. Data are reviewed comparing the once-daily ACE inhibitor lisinopril with captopril or enalapril in patients already receiving digoxin and/or diuretics for heart failure. Data are also reviewed which compare lisinopril with digoxin in patients already receiving diuretics alone for heart failure. Lisinopril is more effective than placebo and at least as effective as captopril or enalapril in these comparative studies on the basis of haemodynamics, exercise test results and clinical signs and symptoms of heart failure. Lisinopril may also be a suitable alternative, as well as being an adjunct, to digoxin in patients already receiving diuretics alone. Lisinopril is usually well tolerated in patients with heart failure. The mechanism of benefit of ACE inhibitors in heart failure is not clear, but apart from blockade of the renin-angiotensin-aldosterone system (RAAS), may also involve modulation of sympathetic stimulation, cardioreparation and regulation of potassium balance. The new ATLAS study (Assessment of Treatment with Lisinopril And Survival) is being conducted to address the question of whether ACE inhibitors in general practice should be given at the current low doses, or at the higher doses used in large survival studies.