Anales de medicina interna (Madrid, Spain : 1984)

[Lisinopril in the treatment of heart insufficiency].

PMID 7669880


The prognosis in patients with heart failure (HF) is poor. The angiotensin converting enzyme (ACE) inhibitors are among the most promising of current options, with benefits not only in terms of haemodynamic and clinical improvement but also in mortality. Data are reviewed comparing the once-daily ACE inhibitor lisinopril with captopril or enalapril in patients already receiving digoxin and/or diuretics for heart failure. Data are also reviewed which compare lisinopril with digoxin in patients already receiving diuretics alone for heart failure. Lisinopril is more effective than placebo and at least as effective as captopril or enalapril in these comparative studies on the basis of haemodynamics, exercise test results and clinical signs and symptoms of heart failure. Lisinopril may also be a suitable alternative, as well as being an adjunct, to digoxin in patients already receiving diuretics alone. Lisinopril is usually well tolerated in patients with heart failure. The mechanism of benefit of ACE inhibitors in heart failure is not clear, but apart from blockade of the renin-angiotensin-aldosterone system (RAAS), may also involve modulation of sympathetic stimulation, cardioreparation and regulation of potassium balance. The new ATLAS study (Assessment of Treatment with Lisinopril And Survival) is being conducted to address the question of whether ACE inhibitors in general practice should be given at the current low doses, or at the higher doses used in large survival studies.