The regulatory adaptive status in hypertensive patients with congestive heart failure with preserved left ventricular ejection fraction: the effects of fosinopril versus zofenopril

Abstract

Objective. To evaluate the impact of fosinopril versus zofenopril on the regulatory adaptive status (RAS) in hypertensive patients with chronic heart failure (CHF) with preserved left ventricular (LV) ejection fraction (EF). Design and methods. The study inclded 67 hospitalized patients with hypertension (HTN) and CHF I–II NYHA functional classes with LV EF ≥ 50 %, who were randomized into two groups for treatment with fosinopril (13,8 ± 4,1 mg/day, n = 32) or zofenopril (17,9 ± 5,9 mg/day, n = 35). All patients additionally received nebivolol (7,1 ± 1,9 and 6,9 ± 1,8 mg/day), and if needed, atorvastatin and acetylsalicylic acid were prescribed. At baseline and after 24 weeks, we performed quantitative assessment of RAS-regulatory-adaptive capabilities (by cardio-respiratory coupling test), echocardiography, treadmill test, six-minute walking test, assessment of the N-terminal brain natriuretic pro-peptide level in blood plasma, subjective evaluation of quality of life (QL). Results. Fosinopril versus zofenopril led to a greater improvement of RAS (by 69,0%, p < 0,01 versus 41,1%, p < 0,01) and to a higher increase in tolerance to physical activity: longer distance in a six-minute walk test (by 28,1 %, p < 0,05 versus 25,9 %, p < 0,05), improvement in functional class of CHF (from II to I in 56 % of patients, in 25 % CHF was not registered versus change from II to I in 42 % of patients, and no CHF in 14 %). In both groups, cardiac diastolic function improved (decreased VE/Ve by 39,5%, p < 0,01 and 37,8%, p < 0,01), neurohumoral hyperactivity reduced (NT-proBNP decreased by 40,6 %, p < 0,01 and 39,4 %, p < 0,01), and subjective QL increased (decrease in the amount of negative points by 69,3%, p < 0,01, and 64,9 %, p < 0,01). Conclusions . In HTN patients with CHF with preserved LV EF, fosinopril versus zofenopril may be preferable due to a greater impact on regulatory and adaptive capabilities.