Fosinopril and enalapril showed similar short-term event-free survival for cardiac death and heart failure hospitalization (86.7% vs. 82.8%, p=0.43) in patients with systolic heart failure.
RCT (n=59)
randomized
Does fosinopril improve event-free survival and functional outcomes compared to enalapril in patients with systolic heart failure?
Fosinopril and enalapril have similar short-term effects on event-free survival and functional capacity in systolic heart failure, but fosinopril is associated with a longer time to event and a more favorable renal profile.
Effect estimate: log rank 4.21
Absolute Event Rate: 86.7% vs 82.8%
p-value: p=0.43
INTRODUCTION: The aim of this study was to evaluate short-term clinical, biochemical and functional effects of fosinopril versus enalapril in patients with heart failure. MATERIAL AND METHODS: 59 consecutive patients (mean age 57 +/- 8 years, EF 18.9 +/- 6.3%, NYHA III or IV class 19/59) were randomized to receive fosinopril or enalapril for three months. All patients underwent echocardiography, metabolic testing, and a 6-minute walk test and completed the Minnesota questionnaire on inclusion and three months later. Additionally, serum creatinine, BUN, total cholesterol and triglycerides were measured. Kaplan-Meier curve was created to assess event-free survival for cardiac death and hospitalization for heart failure. RESULTS: There was no statistically significant difference in event-free survival between patients on fosinopril and enalapril (86.7% vs. 82.8%, log rank 4.21 p=0.43). However, time to the event was longer in patients on fosinopril (77.0 +/- 25.35 vs. 40.2 +/- 6.8 days, p=0.04). At the end of the study, no difference between fosinopril and enalapril group existed with respect to maximal oxygen consumption (20.90 +/- 4.47 vs. 20.89 +/- 6.86 ml/kg/min), ejection fraction (20.5 +/- 7.4 vs. 21.4 +/- 7.8%), distance during the 6-minute test walk (313 +/- 74 vs. 352 +/- 129 meters) and quality of life (23.8 +/- 15.8 vs. 25.6 +/- 20.3 points), but patients on enalapril had higher creatinine (99 +/- 13 vs. 113 +/- 17 micromol/L, p=0.002) and BUN (7.28 +/- 1.7 vs. 8.89 +/- 2.39 mmol/L, p=0.01) levels. Increase in fosinopril dose during the study was higher than increase in enalapril dose (24.1% +/- 23.8% vs. 9.5 +/- 24.5%, p=0.04). CONCLUSIONS: Fosinopril and enalapril have similar short-term effects on event-free survival, ejection fraction, functional capacity and quality of life in patients with heart failure. Patients on fosinopril presented with longer survival without event and had lower creatinine and BUN at the end-of the follow-up. Additionally, fosinopril can be easily titrated to the maximum therapeutic dose.
Otašević et al. (2006) conducted an RCT in systolic heart failure (n=59). Fosinopril vs. Enalapril was evaluated on Event-free survival for cardiac death and hospitalization for heart failure (log rank 4.21, p=0.43). Fosinopril and enalapril showed similar short-term event-free survival for cardiac death and heart failure hospitalization (86.7% vs. 82.8%, p=0.43) in patients with systolic heart failure.