Regulatory adaptive status in determining the effectiveness of lisinopril and fosinopril in patients with chronic heart failure with preserved left ventricular ejection fraction

Abstract

Aim. To determine effectiveness of combination therapy with lisinopril and fosinopril in patients with chronic heart failure (CHF) with preserved left ventricular ejection fraction (LV EF), considering its impact on the regulatory and adaptive capabilities organism. Materials and methods. 80 patients were examined with CHF II functional class with preserved systolic function of the left ventricle (left ventricular ejection fraction ≥50%) (classification of the New York Heart Association) in the presence of hypertension disease (HD) III stage and/or ischemic heart disease (IHD). Randomly divided into two equal groups. In the first group was appointed for treatment with lisinopril (the average dose was 14.0±3.8 mg/day), in the second group - fosinopril (the average dose - 14.7±4.2 mg/day). All patients were prescribed nebivolol (7.1±2.2 mg/day and 6.8±2.1 mg/day). Depending on the concomitant pathology were appointed acetylsalicylic acid in the intestinal shell (100 mg/day, n=9 and 100 mg/day, n=10) and atorvastatin (15.3±4.9 mg/day, n=15 and 16.5±4.8 mg/day, n=17). Initially and after six months later of combined pharmacotherapy studied: a quantitative assessment of regulatory and adaptive capabilities of the organism, echocardiography, treadmill test, six-minute walk test, determination in blood plasma of the N-terminal precursor of the natriuretic brain peptide level, all-day monitoring of blood electrocardiograms and pressure. The quality of life was also assessed using a questionnaire. Results. Both treatment regimens of patients equally improved the structural and functional parameters of the heart, reduced neurohumoral activity, optimized heart rate and pulse. In this case, treatment with fosinopril is more pronounced positively regulatory-adaptive capacity and tolerance to physical load, and also there was an improvement in the quality of life. Conclusion. In patients with CHF with preserved LV EF, in the presence of HD and/or IHD combined pharmacotherapy with fosinopril in comparison with lisinopril probably is preferable due to the more pronounced increase in regulatory and adaptive capabilities.