A head-to-head evaluation of the effect of
ramipril and
zofenopril on the cardiovascular mortality rate of patients with chronic
heart failure (HF) in the setting of clinical practice is not yet available. We prospectively enrolled 224 patients with all-cause HF, who were untreated with
angiotensin-converting enzyme inhibitors or
angiotensin receptor blockers. These patients were then assigned to
zofenopril 15 to 30 mg/day or
ramipril 5 to 10 mg/day on the basis of a prospective, randomized, open, blinded, end point trial. The primary outcome of the trial was patient survival during the follow-up period. The groups were similar in a large number of clinical parameters. The mean follow-up of this cohort was 6.1 ± 1.2 years. Overall, during the follow-up period, we observed 45 deaths in the
zofenopril-treated group and 48 in the
ramipril-treated group (p = 0.251).
Zofenopril and
ramipril appears to be equivalent regarding the effects on cardiovascular mortality in the entire sample.
Zofenopril was a significant predictor of better survival in patients who were the median age or older (odds ratio 0.56, 95% confidence interval 0.35 to 0.91), in men (odds ratio 0.57, 95% confidence interval 0.30 to 0.98), and in patients with a lower ejection fraction (odds ratio 0.52, 95% confidence interval 0.26 to 0.97). In conclusion, in the clinical practice setting,
ramipril and
zofenopril seem to have similar effects on cardiovascular mortality. However
zofenopril might be more efficacious in elderly patients, male patients, and patients with a lower ejection fraction.