What are the benefits of using captopril (Angiotensin-Converting Enzyme inhibitor) versus lisinopril (Angiotensin-Converting Enzyme inhibitor) in patients with cardiomyopathy?

From the Guidelines

Lisinopril is preferred over captopril for the management of cardiomyopathy due to its once-daily dosing, longer half-life, and potential for improved medication adherence, although captopril may be considered in acute settings where rapid titration is necessary. The choice between captopril and lisinopril depends on the clinical scenario, with captopril offering benefits in acute settings due to its shorter duration of action (6-12 hours), allowing for more rapid dose titration and easier management if hypotension occurs 1. However, lisinopril provides advantages for long-term management with once-daily dosing (typically 5-40 mg daily), potentially improving medication adherence, and has a longer half-life, providing more consistent blood pressure control over 24 hours.

Some key points to consider when choosing between captopril and lisinopril include:

• The clinical scenario: captopril for acute settings, lisinopril for chronic management
• Dosing frequency: captopril requires multiple daily dosing, lisinopril is once-daily
• Half-life: lisinopril has a longer half-life, providing more consistent blood pressure control
• Medication adherence: lisinopril may improve adherence due to once-daily dosing
• Monitoring requirements: both medications require monitoring of blood pressure, renal function, and potassium levels, especially during initiation and dose adjustments 1.

It's also important to note that both medications effectively reduce afterload, improve cardiac output, and slow ventricular remodeling in cardiomyopathy patients, and the decision between them should be based on individual patient needs and clinical circumstances. Additionally, the use of ARBs, such as valsartan, may be considered as an alternative to ACE inhibitors in patients who do not tolerate ACE inhibitors and have clinical signs of heart failure and/or an EF ≤40% 1.

From the FDA Drug Label

Captopril tablets are indicated in the treatment of congestive heart failure usually in combination with diuretics and digitalis The beneficial effect of captopril in heart failure does not require the presence of digitalis, however, most controlled clinical trial experience with captopril has been in patients receiving digitalis, as well as diuretic treatment Captopril tablets are indicated to improve survival following myocardial infarction in clinically stable patients with left ventricular dysfunction manifested as an ejection fraction <40% and to reduce the incidence of overt heart failure and subsequent hospitalizations for congestive heart failure in these patients

Lisinopril was approximately equivalent to atenolol and metoprolol in reducing diastolic blood pressure, and had somewhat greater effects on systolic blood pressure. In two placebo controlled, 12-week clinical studies compared the addition of lisinopril up to 20 mg daily to digitalis and diuretics alone. The combination of lisinopril, digitalis and diuretics reduced the following signs and symptoms of heart failure: edema, rales, paroxysmal nocturnal dyspnea and jugular venous distention

The benefits of using captopril versus lisinopril in patients with cardiomyopathy are not explicitly stated in the provided drug labels.

• Both captopril and lisinopril are indicated for the treatment of heart failure and have been shown to be effective in reducing symptoms and improving outcomes in patients with heart failure.
• However, the labels do not provide a direct comparison of the two drugs in patients with cardiomyopathy.
• Therefore, no conclusion can be drawn about the relative benefits of captopril versus lisinopril in this specific patient population 2, 3.

From the Research

Benefits of Captopril vs Lisinopril in Cardiomyopathy

• The benefits of using captopril versus lisinopril in patients with cardiomyopathy are not extensively compared in the provided studies, but some insights can be gathered from the available data 4, 5, 6, 7, 8.
• Lisinopril has been shown to be effective in lowering blood pressure and improving symptoms in patients with congestive heart failure, with benefits including reduced risk of major clinical events and improved exercise tolerance 4, 5, 6.
• In a study comparing lisinopril and captopril, lisinopril was found to be superior in improving exercise duration and left ventricular ejection fraction in patients with congestive heart failure, particularly in those with renal impairment 8.
• Captopril has been shown to be effective in improving indices of cardiac function in patients with congestive heart failure, but the comparison with lisinopril is limited 7, 8.
• The choice between captopril and lisinopril may depend on individual patient factors, such as renal function and tolerance to the medication, as well as the specific clinical context 4, 5, 6, 7, 8.

Comparison of Efficacy

• Lisinopril has been shown to be at least as effective as captopril in improving symptoms and clinical status in patients with heart failure 6, 8.
• High doses of lisinopril (32.5-35mg once daily) have been shown to be more effective than low doses (2.5-5mg once daily) in reducing the risk of major clinical events in patients with heart failure 6.
• Captopril has been shown to be effective in improving cardiac function and exercise tolerance in patients with congestive heart failure, but the comparison with lisinopril is limited 7, 8.

Safety and Tolerability

• Both lisinopril and captopril are generally well tolerated, with common adverse events including dizziness, headache, and hypotension 4, 5, 6, 7, 8.
• Lisinopril has been shown to have a good safety profile, with no significant increase in adverse events with high doses 6.
• Captopril has been shown to be well tolerated, but the comparison with lisinopril is limited 7, 8.