delapril (cas 110508-92-4) versus enalapril in patients with congestive heart failure

Add time:08/14/2019    Source:sciencedirect.com

This 12-month, multicenter, randomized, parallel-group study compared the effects of delapril (cas 110508-92-4) with enalapril in 179 patients with congestive heart failure, New York Heart Association (NYHA) classes II and III. The initial doses of delapril (7.5 mg twice daily [BID]) and enalapril (2.5 mg BID) could be doubled every other week, to a maximum of 30 mg BID and 10 mg BID, respectively. Efficacy was assessed based on the changes in NYHA class, echocardiographic variables, cardiothoracic ratio, left ventricular end-diastolic volume, left ventricular end-systolic volume, left ventricular systolic wall stress, ejection fraction results of the exercise test, and patient's opinion of clinical status using a 4-point scale. Safety was assessed by monitoring the adverse events, laboratory tests, blood pressure, and electrocardiography. A significant decrease in left ventricular end-systolic volume was observed in the delapril group after 3 (P < 0.01), 6 (P < 0.01), and 12 (P < 0.05) months; no significant changes were seen in the enalapril group in this period. Both treatments significantly reduced wall stress and improved ejection fraction at 3 (delapril, P < 0.01; enalapril, P < 0.05), 6 (P < 0.01 for both groups), and 12 (delapril, P < 0.01; enalapril, P < 0.05) months, and significantly improved ejection fraction (P < 0.01). None of the between-group differences were significant. Both treatments produced a significant improvement compared with baseline in the duration of exercise, workload, and work performed at 3 and 12 months. There was a significant difference between treatments in workload at 3 months (P < 0.05) in favor of delapril. Heart rate was significantly reduced at day 30 (P < 0.01), day 45 (P < 0.05), and month 6 (P < 0.05) only in the delapril group. The frequency and type of adverse events were similar in the 2 groups. One-year mortality was 5.7% in the delapril group and 6.6% in the enalapril group. These results suggest that treatment with delapril, an angiotensin-converting enzyme (ACE) inhibitor with affinity and selectivity for the C-site of the left ventricle and coronary arteries, may have some modest benefits when compared with a nonselective ACE inhibitor such as enalapril. However, more study is needed in larger patient populations.

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