From the FDA Drug Label
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 A large (over 3,000 patients) survival study, the ATLAS Trial, comparing 2. 5 mg and 35 mg of lisinopril in patients with systolic heart failure, showed that the higher dose of lisinopril had outcomes at least as favorable as the lower dose
The effect of Lisinopril on left-sided heart failure with reduced ejection fraction is well documented, with studies showing that it can reduce signs and symptoms of heart failure and improve outcomes. However, there is no direct information in the provided drug label about the effect of Lisinopril on right-sided heart failure with reduced ejection fraction. The FDA drug label does not answer the question.
From the Research
Lisinopril is beneficial for patients with right-sided heart failure and reduced ejection fraction, as it helps prevent cardiac remodeling and slows disease progression. The typical starting dose is 2.5-5 mg once daily, which can be gradually increased to a target dose of 20-40 mg daily as tolerated 1. Lisinopril, an ACE inhibitor, works by blocking the conversion of angiotensin I to angiotensin II, reducing blood pressure, decreasing cardiac workload, and improving cardiac output. This medication helps improve symptomatic end-points and clinical status in patients with heart failure, as demonstrated in short-term randomized, double-blind, parallel-group, multicentre clinical trials 1. When starting lisinopril, monitor blood pressure, kidney function, and potassium levels regularly. Common side effects include dry cough, dizziness, and hypotension. Lisinopril should be used cautiously in patients with severe renal impairment or hyperkalemia. For right-sided heart failure specifically, diuretics are often prescribed alongside ACE inhibitors to manage fluid overload. The medication may take several weeks to show significant improvement in symptoms and ejection fraction. If a dry cough develops, consider switching to an angiotensin receptor blocker (ARB) like losartan as an alternative. It's worth noting that sacubitril/valsartan may also be used to treat right ventricular dysfunction in patients with heart failure with reduced ejection fraction, as it has been shown to improve right ventricular function indicators such as tricuspid annular plane systolic excursion and pulmonary artery systolic pressure 2. However, the use of lisinopril is still supported by the evidence as a beneficial treatment for patients with right-sided heart failure and reduced ejection fraction.
Some key points to consider when using lisinopril in patients with right-sided heart failure include:
- Monitoring for signs of worsening heart failure, such as increased shortness of breath or fatigue
- Adjusting the dose of lisinopril based on patient response and tolerance
- Using diuretics to manage fluid overload and reduce symptoms of heart failure
- Considering alternative treatments, such as sacubitril/valsartan, if patients do not respond to lisinopril or experience adverse effects. Overall, the evidence supports the use of lisinopril as a beneficial treatment for patients with right-sided heart failure and reduced ejection fraction, and it should be considered as part of a comprehensive treatment plan for these patients 1, 3.