Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Aim. To compare clinical and haemodynamic efficacy of ramipril vs enalapril in women with chronic heart failure (CHF).

Material and methods. 60 women with non valvular CHF were included in the study. Patients were randomized in groups of ramipril or enalapril taken in addition to standard therapy. CHF severity, heart morphofunctional parameters, life quality, exercise tolerance, biomarkers (brain natriuretic peptide, von Willebrand factor) was estimated in patients initially and after 6 months of therapy.

Results. Ramipril average daily dose was 11,4 mg, enalapril average daily dose - 34,2 mg. Dry cough was observed more rarely in patients treated with ramipril than in patients treated with enalapril. There was a trend to higher increase of exercise tolerance due to ramipril therapy in comparison with enalapril one (р=0,062). Ramipril, but not enalapril, reduced a number of patients with diastolic dysfunction (р=0,049). Life quality improvement was higher in ramipril treated patients in comparison with those treated with enalapril (р=0,04). Brain natriuretic peptide and von Willebrand factor levels decreased more significantly in ramipril therapy than in enalapril one (р=0,05 and р<0,05 , respectively).

Conclusion. Ramipril therapy of CHF in women has higher clinical efficacy and better tolerability in comparison with enalapril therapy.

About the Authors

S. N. Tereshchenko
Moscow State University of Medicine and Dentistry
Russian Federation

I. V. Zhirov
Moscow State University of Medicine and Dentistry
Russian Federation

E. V. Malichenko
Moscow State University of Medicine and Dentistry
Russian Federation

E. E. Kazantseva
Moscow State University of Medicine and Dentistry
Russian Federation


1. Oakley C. Peripartum cardiomyopathy. In: Women&Heart Disease, 2nd edition. Eds: Wenger N. and Collins P. London: Taylor&Francis; 2005.

2. Meibohm B., Beierle I., Derendorf H. How important are gender differences in pharmacokinetics. Clin Pharmacokinet 2002;41:329-42.

3. Weinberg E., Thienelt C., Katz S. et al. Gender differences in molecular remodeling in pressure overload hypertrophy. J Am Coll Cardiol 1999;34:264-73.

4. Pfeffer J., Pfeffer M., Fletcher P. et al. Favorable effects of therapy on cardiac performance in spontaneously hypertensive rats. Am J Physiol 1982;242:H776-H784.

5. Carroll J., Carroll E., Feldman T. et al. Sex-associated differences in left ventricular function in aortic stenosis of the elderly. Circulation 1992;86:1099-107.

6. Aurigemma G., Gaasch W. Gender differences in older patients with pressure-overload hypertrophy of the left ventricle. Cardiology 1995;86:310-7.

7. Mendez L., Davidoff R., Cupples L. Et al. Congestive heart failure in patients with coronary artery disease: the gender paradox. Am Heart J 1997;134:207-12.

8. Krumholz H., Larson M., Levy D. Sex differences in cardiac adaptation to isolated systolic hypertension. Am J Cardiol 1993;72:310-3.

9. Guerra S., Leri A., Wang X. Et al. Myocyte death in the failing human heart is gender dependent. Circ Res 1999;85:856-66.

10. Olivetti G., Giordano G., Corradi D. et al. Gender differences and aging: effects on the human heart. J Am Coll Cardiol 1995;26:1068-79.

11. Fischer M., Baessler A., Schunkert H. Renin angiotensin system and gender differences in the cardiovascular system. Cardiovasc Res 2002;53:672-7.

12. Jochmann N., Stangl K., Garbe E. et al. Female-specific aspects in the pharmacotherapy of chronic cardiovascular disease. Eur Heart J 2005;26:1585-95.

13. Shekelle P., Rich M., Morton S. et al. Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender and diabetic status: a meta-analysis of major clinical trials. J Am Coll Cardiol 2003;41:1529-38.

14. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993;342(8875):821-8.

15. Boneu B., Abbal M., Plante J., Bierme R. Factor VIII complex and endothelial damage. Lancet 1975;30:325-33.

16. Reidy MA, Chopek M, Chao S, et al. Injury induces increase of von Willebrand factor in rat endothelial cells. Am J Pathol 1989;134:857-864.

17. Over J., Sixma J.J. et al. Survival of 125-iodine labeled factor VIII in normals and patients with classical hemophilia. Observations on the heterogeneity of human factor VIII. J Clin Invest 1978;62:223-34.

18. Поливода С.Н., Черепок А.А. Фактор Виллебранда как маркер эн- дотелиальной дисфункции у пациентов с заболеваниями сердечно- сосудистой системы. Укр ревматол журн 2000;(7):13-7.

19. Gao Z., Liu F., Yu Z. et al. Effects of von Willebrand factor concentration and platelet collision on shear-induced platelet activation. Thromb Haemost 2008;100(1):60-8.

20. Montalescot G., Philippe F., Vicaut E. and the French Investigators of the ESSENCE Trial. Early increase of von Willebrand factor predicts adverse outcome in unstable coronary artery disease. Circulation 1998;98:294-9.

21. Ewenstein B.M., Warhol M.J., Handin R.I., Pober J.S. Composition of the von Willebrand factor storage organelle (Weibel-Palade body) isolated from cultured human umbilical vein endothelial cells. J Cell Biol 1987;104:1423-33.

22. Verweij C.L. Biosynthesis of human von Willebrand factor. Haemostasis 1988;18:224-45.

23. Bowie E.J.W., Solberg L.A., Fass D.N. et al. Transplantation of normal bone marrow into a pig with severe von Willebrand disease. J Clin Invest 1986;78:26-30.

24. Bellucci S., Ignatova E., Jaillet N., Boffa M.C. Platelet hyperactivation in patient with essential thrombocythemia is not associated with vascular endothelial cell damage as judged by the levels of plasma thrombomodulin? Protein S, PAI-1, tPA and vWF. Thromb Haemost 1993;70:736-42.

25. Green D., Kucuk O., Haring O., Dyer A. The factor VIII complex in atherosclerosis: effects of aspirin. J Chron Dis 1982;34:21-26.

For citation:

Tereshchenko S.N., Zhirov I.V., Malichenko E.V., Kazantseva E.E. COMPARATIVE EFFICACY OF ACE INHIBITORS (RAMIPRIL VS ENALAPRIL) IN TREATMENT OF CHRONIC HEART FAILURE IN WOMEN. Rational Pharmacotherapy in Cardiology. 2008;4(3):19-25. (In Russ.)

Views: 4602

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)