Comparison of the First Dose Response of Fosinopril and Captopril in Congestive Heart Failure A Randomized, Double-Blind, Placebo Controlled Study

• Published in: Japanese Heart Journal Vol. 42; no. 2; pp. 185 - 191
• Main Authors: Eryonucu, Beyhan, Koldas, Lale, Ayan, Faruk, Keser, Nurgul, Sirmaci, Necati
• Format: Journal Article
• Language: English
• Published: Tokyo International Heart Journal Association 01.03.2001; Japanese Heart Journal Association
• Subjects: Administration, Oral; Aged; Angiotensin converting enzyme; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Antihypertensive Agents - administration & dosage; Biological and medical sciences; Blood Pressure - drug effects; Captopril; Captopril - administration & dosage; Dose-Response Relationship, Drug; Double-Blind Method; Drug toxicity and drugs side effects treatment; Female; First dose hypotension; Fosinopril; Fosinopril - administration & dosage; Heart Failure - drug therapy; Heart Failure - physiopathology; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Toxicity: cardiovascular system; Human; Heart failure; Vasodilator agent; Enzyme; Captopril; Toxicity; Enzyme inhibitor; Cardiovascular disease; Peptidases; Chemotherapy; Treatment; Peptidyl-dipeptidase A; Heart disease; Arterial hypotension; Hydrolases; Peptidyl-dipeptidases; Fosinopril; Comparative study
• ISSN: 0021-4868; 1348-673X
• DOI: 10.1536/jhj.42.185

The purpose of this study was to compare the safety and tolerability of recommended initial doses of fosinopril (FOS) with those of captopril (CAP), in diuretic-treated, salt depleted “high risk” patients with congestive heart failure. Thirty patients were randomized in a double blind fashion to receive a single dose of either FOS 10 mg, CAP 6.25 mg or placebo. CAP produced a significant early and brief fall in BP, while the first-dose hypotensive response with FOS did not differ significantly from placebo. Baseline plasma angiotensin converting enzyme (ACE) activity was similar in all groups. Only CAP showed an acute and significant fall in plasma ACE activity, whereas FOS and placebo did not change ACE activity. There was no correlation between mean arterial pressure or percentile change in mean arterial pressure and plasma ACE activity. Also no correlation was found between high or low ACE activity level and first dose hypotension. The practical importance of the results are: For patients with congestive heart failure, FOS and CAP have different effects on BP after the first dose, and this effect may be dependent on the plasma ACE activity level. FOS produces ACE inhibition and BP changes similar to placebo so it is the safer choice for the treatment of congestive heart failure.