Clinical evaluation of aceis in treatment of congestive heart failure

ABSTRACT

This trial was performed to evaluate and compare the efficacy of angiotensin converting enzyme inhibitors [ACEIs] in the treatment of congestive heart failure [CHF]. The selected ACEIs were captopril [as an example of direct acting drugs with short duration], lisinopril [as an example of direct acting drugs with long duration] and ramipril [as an example of prodrugs]. The drugs were evaluated in sixty two patients with New York Heart Association functional class Ill and IV despite treatment with digoxin and diuretics. After baseline assessment and adjustment of digoxin and diuretic dosages to the optimal regimen, patients were randomly assigned to treatment with 25mg captopril [increased to 50mg] as 2 divided doses [20 patients], 5mg lisinopril [increased to 10mg] as a single dose [13 patients], 2.5mg ramipril [increased to 5mg] as 2 divided doses [18 patients] or placebo [11 patients] in a blind fashion for a period of 3 months. Lisinopril after the treatment period although, it improved dyspnea and fatigue, it didn't produce any significant changes as regards orthopnea or echocardiography. Both captopril and ramipril after the treatment period significantly improved dyspnea, fatigue and orthopnea. Also, they significantly increased each of the left ventricular ejection fraction and shortening fraction. Captopril didn't influence renal function, however, ramipril unlike captopril significantly increased serum creatinine and blood urea nitrogen. In conclusion, we prefer the short acting ACEI captopril as adjuvant therapy in the treatment of CHF as it was clinically effective and tolerable