Delapril versus enalapril in patients with congestive heart failure

This 12-month, multicenter, randomized, parallel-group study compared the e ffects of delapril with enalapril in 179 patients with congestive heart fai lure, New York Heart Association (NYHA) classes II and III. The initial dos es 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, respe ctively. Efficacy was assessed based on the changes in NYHA class, echocard iographic variables, cardiothoracic ratio, left ventricular end-diastolic v olume, left ventricular end-systolic volume, left ventricular systolic wall stress, ejection fraction results of the exercise test, and patient's opin ion of clinical status using a 4-point scale. Safety was assessed by monito ring the adverse events, laboratory tests, blood pressure, and electrocardi ography. 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 improve d 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) mon ths, and significantly improved ejection fraction (P < 0.01). None of the b etween-group differences were significant. Both treatments produced a signi ficant improvement compared with baseline in the duration of exercise, work load, and work performed at 3 and 12 months. There was a significant differ ence between treatments in workload at 3 months (P < 0.05) in favor of dela pril. 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 a nd 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 resul ts suggest that treatment with delapril, an angiotens-inconverting enzyme ( ACE) inhibitor with affinity and selectivity for the C-site of the left ven tricle and coronary arteries, may have some modest benefits when compared w ith a nonselective ACE: inhibitor such as enalapril. However, more study is needed in larger patient populations.