Comparison of efficacy and safety of fosinopril versus losartan for severe ischemic heart failure with chronic obstructive pulmonary disease

Objective To compare the long term safety and efficacy of fosinopril and losartan in the treatment of ischemic heart failure with chronic obstructive pulmonary disease(COPD).Methods Two hundreds and seventeen patients with ischemic heart failure with COPD were randomly divided into two groups.All patients were given conventional therapy for congestive heart failure and anti inflammatory drugs consisting of digoxin, nitrates, and spirolactone Patients in the fosinopril group ( n =108) were also given fosinopril 20 mg/d The other 108 patients ( n =109) were given losartan 50 mg/d Symptoms, 6 minutes walk testing, left ventricular ejection fraction (LVEF), quality of life (QOL), and the levels of TNF α,IL 1β,IL 6, and ET were assessed after 8 weeks of treatment and during a mean of 24 months follow up.Results The improvement of quality of life and exercise tolerance were similar in two groups TNF α,IL 1β, and IL 6 levels in plasma in losartan group were more remarkably reduced than those in fosinopril group The decrease in plasma ET 1 level in fosinopril group was more apparently than that in losartan group There was not significant difference in mortality (19 in losartan group vs 23 in fosinopril one, P0 05 ) during 24 months' treatment Cough aggravated in 4 patients in losartan group and 14 in fosinopril group in which 6 patients were withdrawn of treatment because of terrible cough Conclusion Fosinopril and losartan can improve QOL and decrease mortality, and losartan may be more safe and efficient in decreasing plasma proinflammatory cytokines for patients with ischemic heart failure and COPD