AN OPEN, PARALLEL-GROUP COMPARISON OF QUINAPRIL AND CAPTOPRIL, WHEN ADDED TO DIURETIC THERAPY, IN THE TREATMENT OF ELDERLY PATIENTS WITH HEART-FAILURE

This study aimed to compare the efficacy, tolerability and first-dose blood-pressure response of once-daily guinapril and twice-daily captop ril when added to diuretic therapy in elderly patients with heart fail ure. The study was performed at a single centre as an open randomised parallel-group study, patients being selected for inclusion from the o utpatient population. Following a starting dose of either 2.5 mg once- daily quinapril, or 6.25 mg twice-daily captopril, patients were revie wed at two-weekly intervals, and following clinical assessment a decis ion was made either to titrate tip to the next medication stage or to enter the patient into the 16-week maintenance phase. Efficacy was ass essed using a six-minute walking test, the New York Heart Association (NYHA) class, a functional lifescale (FLS) questionnaire and the cardi othoracic ratio (CTR) - at study entry and at the end of the maintenan ce phase. Blood pressure was measured for 5 h post-first-dose of medic ation. Sixty-one patients were randomised to treatment: 30 to quinapri l and 31 to captopril. Following withdrawals, data from 36 patients (2 0 on quinapril, 16 on captopril) were available for analysis. The dist ance walked during the six-minute walking test improved in both groups ; the difference between the treatment groups was not statistically si gnificant. There were no significant changes in the FLS or CTR. An ana lysis of change in the NYHA status front study entry to study end show ed a statistically significant difference between the two groups (p = 0.02) in favour of quinapril, Five patients in each group experienced hypotension during the 5 h following the first dose of medication. Thi s study has shown heart failure to be as well controlled by once-daily quinapril as by twice-daily captopril, with comparable effects on fir st-dose blood-pressure response.