Comparison of lisinopril and captopril in the treatment of left ventricular congestive heart failure--influence of duration of action on efficacy and safety.

Data from the lisinopril-captopril comparison trial (6), as well as other data (1, 8, 14, 10) indicate that both long- and short-acting ACEI are effective and safe for the treatment of CHF. An improved effect on LV function and signs and symptoms of CHF as a result of more prolonged unloading of the heart by long-acting ACEI is suggested by the lisinopril-captopril comparison trial, but requires confirmation. An effect on renal function is expected with ACEI treatment of CHF, i.e., increase in BUN and serum creatinine; the greater increase in BUN by lisinopril as compared to captopril reflects more the potency and duration of action of the drug rather than a more serious diverse consequence. In patients with renal insufficiency (serum creatinine greater than 1.6 mg/dl), the more potent, longer-acting ACEI may be required. Advanced CHF, i.e. Class III-IV (NYHA), is a clear indication for the use of ACEI, both for improvement in symptoms and mortality. Indication for ACEI treatment of patients with less severe heart failure awaits the results on ongoing clinical trials.