Comparative efficacy of enalapril and valsartan in heart failure with mid-range ejection fraction

Aim. To compare the effectiveness of the angiotensin-converting enzyme inhibitor enalapril and the angiotensin II receptor antagonist valsartan in patients with heart failure with mid-range ejection fraction (HFmrEF) from the standpoint of the effect on the clinical picture, echocardiographic parameters and the level of the N-terminal fragment of the prohormone brain-type sodium (NT-proBNP).

Methods. 110 patients with heart failure with mid-range ejection fraction were included in the study based on the City Clinical Hospital named after N.I. Pirogov of Orenburg between 2018 and 2020. All patients were divided into two randomized groups. Patients of the first group (n=55) were prescribed enalapril, the second group (n=55) — valsartan. Each patient was followed up for 1 year. The six-minute walk test, NT-pro-brain natriuretic peptide level, echocardiography parameters were assessed in dynamics. Statistical analysis was performed by using Statistica 10.0 software, Shapiro–Wilk, Mann–Whitney, Wilcoxon tests.

Results. During the year of observation in both groups, there was a significant decrease in the functional class of chronic heart failure (p <0.005) without a statistical difference between the groups (p=0.251). The distance during the six-minute walk test increased from 350 (310–400) m to 490 (420–530) m (p <0.001) in the first group, from 360 (330–400) m to 510 (450–520) m (p <0.001) in the second group, also without significant differences (p=0.361). The NT-pro-brain natriuretic peptide level decreased from 491 (410–610) pg/ml to 286 (187–350) pg/ml (p <0.001) in the first group, and from 446 (376–534) pg/ml to 210 (143–343) pg/ml (p <0.001) in the second, with a more significant change in the second group (p=0.020). The dynamics of echocardiography parameters were comparable in the groups (p >0.05), while ejection fraction normalized in 89.1% of patients received enalapril and 92.7% of patients received valsartan.

Conclusion. The efficacy of enalapril and valsartan in heart failure with mid-range ejection fraction is comparable in its effect on the clinical picture and echocardiography parameters with a more pronounced decrease in NT-pro-brain natriuretic peptide when taking valsartan during a year of follow up.