Effect of different angiotensin-converting-enzyme inhibitors on mortality among elderly patients with congestive heart failure

Pilote, Louise; Abrahamowicz, Michal; Eisenberg, Mark; Humphries, Karin; Behlouli, Hassan; Tu, Jack V.
May 2008
CMAJ: Canadian Medical Association Journal;5/6/2008, Vol. 178 Issue 10, p1303
Academic Journal
Background: Existing clinical trial data do not address whether all angiotensin-converting-enzyme (ACE) inhibitors are similarly beneficial in improving survival and reducing the rate of readmission among patients with congestive heart failure. We sought to answer this question using administrative databases from Canada's 3 most populous provinces. Methods: Using linked hospital discharge and prescription claims databases in Quebec, Ontario and British Columbia, we identified all patients 65 years or older who were admitted to hospital because of congestive heart failure between Jan. 1, 1998, and Mar. 31, 2002, and who had not been admitted for the same reason in the 3 years preceding the study period. We analyzed the association between the type of ACE inhibitor prescribed within 30 days after discharge and subsequent mortality using Cox proportional hazards models. We then adjusted for demographic, clinical, physician and hospital-related variables, with additional time-dependent variables representing current drug use and dosage. We chose ramipril as the reference category for comparison with the other ACE inhibitors because it has increasingly been prescribed to patients with congestive heart failure. Results: A total of 43 316 patients with congestive heart failure filled prescriptions for ACE inhibitors within 30 days after discharge from hospital. Demographic, clinical and prescription-related characteristics were similar among users of each type of ACE inhibitor. In the time-dependent model, the mortality associated with 5 ACE inhibitors was similar to that with ramipril: adjusted hazard ratios (and 95% confidence intervals [CIs]) were 0.95 (0.89-1.02) for lisinopril, 0.92 (0.85-1.00) for fosinopril, 0.99 (0.88-1.11) for quinapril, 0.90 (0.77-1.06) for perindopril and 1.00 (0.80-1.24) for cilazapril. However, use of enalapril or captopril was associated with higher mortality compared with ramipril: adjusted hazard ratios (and 95% CIs) were 1.10 (1.04-1.16) for enalapril and 1.13 (1.01-1.26) for captopril. Interpretation: When prescribing ACE inhibitors to patients, physicians should consider a possible 10%-15% increase in mortality with captopril and enalapril compared with ramipril among patients with congestive heart failure.


Related Articles

  • fosinopril.  // Royal Society of Medicine: Medicines;2002, p257 

    The article presents information on fosinopril. The drug is an ACE inhibitor and acts as a vasodilator. It can be used as an antihypertensive and as a congestive heart failure treatment often when other treatments cannot be used. It is frequently administered in conjunction with other classes of...

  • cilazapril.  // Royal Society of Medicine: Medicines;2002, p155 

    The article provides information on the drug cilazapril. Cilazapril is an ACE inhibitor. It is a powerful vasodilator that can be used as an antihypertensive, and in congestive heart failure treatment, often in conjunction with other classes of drug, particularly diuretic drugs. It is...

  • Staril.  // Royal Society of Medicine: Medicines;2002, p508 

    This article presents information on the prescription drug Staril. Staril is a proprietary, prescription-only preparation for the angiotensin converting enzyme inhibitor fosinopril. It can be used as an antihypertensive and in congestive heart failure treatment, and is available as tablets.

  • A case report looking at ACE inhibitors as the cause of angioedema during dental treatment. Raval, P. // British Dental Journal;1/24/2014, Vol. 216 Issue 2, p73 

    Angiotensin converting enzymes, also known as ACE inhibitors are regularly prescribed by doctors in the treatment of congestive heart failure and hypertension. In this case report, we will be looking at the delayed onset of angioedema as a result of ACE inhibitors that occurred during dental...

  • Choosing a first-line drug in the management of elevated blood pressure: What is the evidence? 3: Angiotensin-converting-enzyme inhibitors. Wright, James M. // CMAJ: Canadian Medical Association Journal;8/08/2000, Vol. 163 Issue 3, p293 

    Abstract Elevated blood pressure is associated with an increased risk of cardiovascular illness and death. Efforts to reduce that risk have led to recommendations for a wide array of nondrug and drug therapies. Choosing the optimal first-line drug for hypertensive patients should address a...

  • Tensopril.  // Royal Society of Medicine: Medicines;2002, p527 

    The article presents information on Tensopril, a proprietary, prescription-only preparation of the ace inhibitor captopril. It can be used as an antihypertensive and in heart failure treatment, usually in conjunction with other classes of drug. It is available as tablets.

  • Are Angiotensin-II Antagonists Effective in CHF Treatment? Miller, Karl E. // American Family Physician;10/15/1999, Vol. 60 Issue 6, p1812 

    Presents an abstract of the study `Dose-related beneficial long-term hemodynamic and clinical efficacy of irbesartan in heart failure,' by E. P. Havranek et al., from April 1999 issue of the `Journal of American College Cardiology.'

  • Success of a P&T policy for use of a second ACE inhibitor before switching to an ARB.  // Formulary;Feb2002, Vol. 37 Issue 2, p97 

    Focuses on the use of ACE inhibitor therapy for treatment of congestive heart failure in Miami, Florida. Development of policy by Miami VA Medical Center's P & T Committee for the use of ACE inhibitors; Association of captopril and enlapril with highest incidence of cough; Use of Angiotensin II...

  • Effects of ACE inhibitors in congestive heart failures.  // American Family Physician;10/1/1995, Vol. 52 Issue 5, p1506 

    Reports on a study from the May 10, 1995 issue of the `Journal of the American Medical Association,' by Garg and colleagues who reviewed a variety of studies that examined the effect of ACE inhibitors on morbidity and mortality from congestive heart failures. Reduction of deaths and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics