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ACE inhibitors equally effective in heart failure patients


In the first head-to-head comparison in heart failure patients, a new study from the Institute for Clinical Evaluative Sciences (ICES) shows that the various angiotensin-converting enzyme (ACE) inhibitor drugs are equally effective in keeping heart failure patients from being readmitted to hospital or dying.

Researchers tracked over 6,700 new Ontario heart failure patients 66 years of age and older started on ACE inhibitors following hospital discharge between 1997 and 2000. They compared hospital readmission and death rates between patients on the various ACE inhibitors. Patients were divided into those initiated on enalapril, lisinopril, ramipril, or other ACE inhibitors (benazepril, captopril, cilazapril, fosinopril, perindopril, quinapril, and trandolapril).

Relative to enalapril users, the study authors observed no significant differences in heart failure hospital readmission rates or mortality among users of lisinopril, ramipril, or the other ACE inhibitors.

“Our results confirm a ‘class effect’ of ACE inhibitors in the treatment of congestive heart failure,” said lead author and ICES associate scientist Dr. Karen Tu.

“This means that clinicians need not be concerned that one ACE inhibitor is more efficacious than another in treating heart failure and may focus on dosing convenience and cost when prescribing ACE inhibitors for their patients in the future.”

The study, “Comparison of angiotensin-converting enzyme inhibitors in the treatment of congestive heart failure”, is in the January 18, 2005 issue of the American Journal of Cardiology.

Author affiliations: ICES (All authors); University Health Network, Toronto Western Hospital Family Medicine Centre (Dr. Tu); University Health Network, Division of Cardiology (Dr. Lee); University of Toronto Departments of Family and Community Medicine, Family Healthcare Research Unit (Dr. Tu), Health Policy, Management and Evaluation (Dr. Mamdani), Pharmacy (Dr. Mamdani), and Medicine (Dr. Lee).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Julie Argles
  • Media Relations Officer, ICES
  • (416) 480-4780 or cell (416) 432-8143

Read the Journal Article