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. 1995 May;71(835):287–292. doi: 10.1136/pgmj.71.835.287

Effects of captopril and enalapril on renal function in elderly patients with chronic heart failure.

C A Haffner 1, M J Kendall 1, A D Struthers 1, A Bridges 1, D J Stott 1
PMCID: PMC2398094  PMID: 7596934

Abstract

OBJECTIVE: To compare the effects on renal function of captopril and enalapril in elderly patients with chronic heart failure. DESIGN: A multi-centre double-blind parallel-group comparison of the two angiotensin-converting enzyme (ACE) inhibitors, captopril (12.5 mg bid) and enalapril (2.5 mg bid). SUBJECTS: 80 elderly patients with chronic heart failure (41 in the captopril group, 39 in the enalapril group). MAIN OUTCOME MEASURES: The blood pressure and pulse rate response to the first dose of ACE inhibitor was assessed in all patients. Glomerular filtration rate (GFR) was measured radioisotopically by 99mTcDTPA or 51CrEDTA clearance after three and six months of each treatment. Subgroups were assessed for effective renal plasma flow (33 patients), exercise tolerance (25 patients) and by a symptom-oriented questionnaire (45 patients). RESULTS: No serious adverse effect on GFR was noticed. There was no significant difference between the two treatments in the mean baseline GFR or in changes from baseline at three and six months (captopril mean baseline GFR 49.6 ml min-1 1.76 m-2, enalapril 54.7 ml min-1 1.76 m-2; mean change (95% confidence interval) at three months captopril 12 ml min-1 (+3.0, +21.0), enalapril -2 ml min-1 (-13.0; +9.0); mean change at six months, captopril 3.7 ml min-1 (-6.7; +14.2), enalapril -6.0 ml min-1 (-21.0; +9.4). Significantly more patients given captopril had an improvement in GFR during the study period (26/31 compared with 20/31 enalapril-treated patients at three months, p = 0.0096, and 23/30 compared with 15/27 at six months, p = 0.021). There were no significant changes in effective renal plasma flow. Three patients treated with enalapril developed symptomatic hypotension within three days of starting treatment. Quality of life questionnaires revealed more gastrointestinal symptoms in the enalapril group (p = 0.039). CONCLUSIONS: Captopril seems marginally preferable to enalapril in the treatment of chronic heart failure in elderly patients.

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Selected References

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  1. Cleland J. G., Dargie H. J., Hodsman G. P., Ball S. G., Robertson J. I., Morton J. J., East B. W., Robertson I., Murray G. D., Gillen G. Captopril in heart failure. A double blind controlled trial. Br Heart J. 1984 Nov;52(5):530–535. doi: 10.1136/hrt.52.5.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cohn J. N., Johnson G., Ziesche S., Cobb F., Francis G., Tristani F., Smith R., Dunkman W. B., Loeb H., Wong M. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991 Aug 1;325(5):303–310. doi: 10.1056/NEJM199108013250502. [DOI] [PubMed] [Google Scholar]
  3. Giles T. D., Fisher M. B., Rush J. E. Lisinopril and captopril in the treatment of heart failure in older patients. Comparison of a long- and short-acting angiotensin-converting enzyme inhibitor. Am J Med. 1988 Sep 23;85(3B):44–47. doi: 10.1016/0002-9343(88)90350-6. [DOI] [PubMed] [Google Scholar]
  4. Giles T. D., Katz R., Sullivan J. M., Wolfson P., Haugland M., Kirlin P., Powers E., Rich S., Hackshaw B., Chiaramida A. Short- and long-acting angiotensin-converting enzyme inhibitors: a randomized trial of lisinopril versus captopril in the treatment of congestive heart failure. The Multicenter Lisinopril-Captopril Congestive Heart Failure Study Group. J Am Coll Cardiol. 1989 May;13(6):1240–1247. doi: 10.1016/0735-1097(89)90294-5. [DOI] [PubMed] [Google Scholar]
  5. Giles T. Enalapril in the treatment of congestive heart failure. J Cardiovasc Pharmacol. 1990;15 (Suppl 3):S6–10. doi: 10.1097/00005344-199000153-00002. [DOI] [PubMed] [Google Scholar]
  6. Levine T. B. Effect of angiotensin converting enzyme inhibition on renal function in the treatment of heart failure. Clin Ther. 1989 Jul-Aug;11(4):495–502. [PubMed] [Google Scholar]
  7. MacFadyen R. J., Lees K. R., Reid J. L. Differences in first dose response to angiotensin converting enzyme inhibition in congestive heart failure: a placebo controlled study. Br Heart J. 1991 Sep;66(3):206–211. doi: 10.1136/hrt.66.3.206. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. McLay J. S., McMurray J., Bridges A., Struthers A. D. Practical issues when initiating captopril therapy in chronic heart failure. What is the appropriate dose and how long should patients be observed? Eur Heart J. 1992 Nov;13(11):1521–1527. doi: 10.1093/oxfordjournals.eurheartj.a060095. [DOI] [PubMed] [Google Scholar]
  9. Murphy P. J., Van der Cammen T., Malone-Lee J. Captopril in elderly patients with heart failure. Br Med J (Clin Res Ed) 1986 Jul 26;293(6541):239–240. doi: 10.1136/bmj.293.6541.239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. O'Neill C. J., Bowes S. G., Sullens C. M., Royston J. P., Hunt W. B., Denham M. J., Dobbs R. J., Dobbs S. M. Evaluation of the safety of enalapril in the treatment of heart failure in the very old. Eur J Clin Pharmacol. 1988;35(2):143–150. doi: 10.1007/BF00609243. [DOI] [PubMed] [Google Scholar]
  11. Packer M., Lee W. H., Kessler P. D., Medina N., Yushak M., Gottlieb S. S. Identification of hyponatremia as a risk factor for the development of functional renal insufficiency during converting enzyme inhibition in severe chronic heart failure. J Am Coll Cardiol. 1987 Oct;10(4):837–844. doi: 10.1016/s0735-1097(87)80278-4. [DOI] [PubMed] [Google Scholar]
  12. Packer M., Lee W. H., Yushak M., Medina N. Comparison of captopril and enalapril in patients with severe chronic heart failure. N Engl J Med. 1986 Oct 2;315(14):847–853. doi: 10.1056/NEJM198610023151402. [DOI] [PubMed] [Google Scholar]
  13. Pfeffer M. A., Braunwald E., Moyé L. A., Basta L., Brown E. J., Jr, Cuddy T. E., Davis B. R., Geltman E. M., Goldman S., Flaker G. C. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992 Sep 3;327(10):669–677. doi: 10.1056/NEJM199209033271001. [DOI] [PubMed] [Google Scholar]
  14. Struthers A. D. The clinical pharmacology of angiotensin converting enzyme inhibitors in chronic heart failure. Pharmacol Ther. 1992;53(2):187–197. doi: 10.1016/0163-7258(92)90008-n. [DOI] [PubMed] [Google Scholar]
  15. Waller D. G., Keast C. M., Fleming J. S., Ackery D. M. Measurement of glomerular filtration rate with technetium-99m DTPA: comparison of plasma clearance techniques. J Nucl Med. 1987 Mar;28(3):372–377. [PubMed] [Google Scholar]
  16. Wheeldon N. M., MacDonald T. M., Flucker C. J., McKendrick A. D., McDevitt D. G., Struthers A. D. Echocardiography in chronic heart failure in the community. Q J Med. 1993 Jan;86(1):17–23. [PubMed] [Google Scholar]

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