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Comparative Effectiveness of Enalapril, Lisinopril, and Ramipril in the Treatment of Patients With Chronic Heart Failure: A Propensity Score-Matched Cohort Study

Comparative Effectiveness of Enalapril, Lisinopril, and Ramipril in the Treatment of Patients With Chronic Heart Failure: A Propensity Score-Matched Cohort Study

Hanna Fröhlich, Felix Henning, Tobias Täger, Dieter Schellberg, Morten Grundtvig, Kevin Goode, Anna Corletto, Syed Kazmi, Torstein Hole, Hugo A Katus, Dan Atar, John G F Cleland, Stefan Agewall, Lutz Frankenstein, etc.

Eur Heart J Cardiovasc Pharmacother. 2018 Apr 1;4(2):82-92.

PMID: 28475676

Abstract:

Aims:
Angiotensin-converting enzyme inhibitors (ACEIs) are recommended as first-line therapy in patients with heart failure with reduced ejection fraction (HFrEF). The comparative effectiveness of different ACEIs is not known.
Methods and results:
A total of 4723 outpatients with stable HFrEF prescribed enalapril, lisinopril, or ramipril were identified from three registries in Norway, England, and Germany. In three separate matching procedures, patients were individually matched with respect to both dose equivalents and their respective propensity scores for ACEI treatment. During a follow-up of 21 939 patient-years, 360 (49.5%), 337 (52.4%), and 1119 (33.4%) patients died among those prescribed enalapril, lisinopril, and ramipril, respectively. In univariable analysis of the general sample, enalapril and lisinopril were both associated with higher mortality when compared with ramipril treatment [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.30-1.65, P < 0.001 and HR 1.38, 95% CI 1.22-1.56, P < 0.001, respectively). Patients prescribed enalapril or lisinopril had similar mortality (HR 1.06, 95% CI 0.92-1.24, P = 0.41). However, there was no significant association between ACEI choice and all-cause mortality in any of the matched samples (HR 1.07, 95% CI 0.91-1.25, P = 0.40; HR 1.12, 95% CI 0.96-1.32, P = 0.16; and HR 1.10, 95% CI 0.93-1.31, P = 0.25 for enalapril vs. ramipril, lisinopril vs. ramipril, and enalapril vs. lisinopril, respectively). Results were confirmed in subgroup analyses with respect to age, sex, left ventricular ejection fraction, New York Class Association functional class, cause of HFrEF, rhythm, and systolic blood pressure.
Conclusion:
Our results suggest that enalapril, lisinopril, and ramipril are equally effective in the treatment of patients with HFrEF when given at equivalent doses.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP83915837	Lisinopril		83915-83-7	Price

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