Use of different types of angiotensin converting enzyme inhibitors and mortality in systolic heart failure

BackgroundAngiotensin converting enzyme-inhibitors (ACEIs) are the first-line treatment for patients with heart failure (HF) with reduced ejection fraction (EF). The benefit of ACEIs in HF is regarded as a class effect and different types of agents are used interchangeably. However, evidence on the comparable effectiveness of different ACEIs is scarce. We conducted a registry-based cohort study to assess all-cause mortality associated with the use of enalapril, perindopril, and trandolapril, as compared with ramipril, in patients with systolic HF.MethodsPatients with systolic HF (EF ≤ 40%), 2003-2012, were identified using the Danish HF Registry. New users of enalapril (n = 1807), perindopril (n = 1064), ramipril (n = 3270), or trandolapril (n = 1150), who started treatment within 60 days of first-time hospital diagnosis of HF, were selected for inclusion. Subgroup analyses were conducted by sex, age, NYHA-level, EF, and ischemic heart disease. All analyses were adjusted for empirical risk scores for mortality.ResultsDuring follow-up, 291 deaths were observed among users of enalapril (incidence rate per 100 person-years [IR], 10.1), 212 among users of perindopril (IR, 10.5), 568 among users of ramipril (IR, 10.6), and 251 among users of trandolapril (IR, 12.1). No significant differences in all-cause mortality were observed with the use of enalapril (adjusted hazard ratio [aHR] 0.95, 95% CI 0.82-1.10), perindopril (aHR 1.07, 95% CI 0.92-1.26), or trandolapril (aHR 1.08, 95% CI 0.93-1.26), as compared with ramipril. No significant differences were observed in subgroup analyses.ConclusionsThese findings suggest equal effect of different types of ACEIs on mortality in systolic HF.