福辛普利与依那普利对收缩性心力衰竭患者临床、生化及功能影响的头对头比较

[Head-to-head comparison of clinical, biochemical and functional effects of fosinopril and enalapril in patients with systolic heart failure].

作者信息

Otasević Petar, Putiniković Biljana, Vukajlović Zelimir, Ilisić Bojan, Nesković Aleksandar N

机构信息

Institut za kardiovaskularne bolesti Dedinje Centar za kardiovaskularna istrazivanja Dr Aleksandar D. Popović.

出版信息

Med Pregl. 2006 Jan-Feb;59(1-2):51-6. doi: 10.2298/mpns0602051o.

DOI:10.2298/mpns0602051o

PMID:17068892

Abstract

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.

摘要

引言

本研究旨在评估福辛普利与依那普利对心力衰竭患者的短期临床、生化及功能影响。

材料与方法

59例连续入选患者（平均年龄57±8岁，射血分数18.9±6.3%，纽约心脏病协会III或IV级19/59）被随机分为接受福辛普利或依那普利治疗三个月。所有患者在入选时及三个月后均接受超声心动图、代谢测试及6分钟步行试验，并完成明尼苏达问卷。此外，还测量了血清肌酐、尿素氮、总胆固醇和甘油三酯。绘制Kaplan-Meier曲线以评估无心脏性死亡和心力衰竭住院的无事件生存期。

结果

服用福辛普利和依那普利的患者在无事件生存期方面无统计学显著差异（86.7%对82.8%，对数秩检验4.21，p=0.43）。然而，服用福辛普利的患者发生事件的时间更长（77.0±25.35对40.2±6.8天，p=0.04）。研究结束时，福辛普利组和依那普利组在最大耗氧量（20.90±4.47对20.89±6.86 ml/kg/min）、射血分数（20.5±7.4对21.4±7.8%）、6分钟步行试验距离（313±74对352±129米）及生活质量（23.8±15.8对25.6±20.3分）方面无差异，但服用依那普利的患者肌酐水平（99±13对113±17微摩尔/升，p=0.002）和尿素氮水平（7.28±1.7对8.89±2.39毫摩尔/升，p=0.01）更高。研究期间福辛普利剂量的增加高于依那普利剂量的增加（24.1%±23.8%对9.5±24.5%，p=0.04）。