ACE inhibitors in a multimorbid patient: focus on fosinopril
DOI: 10.32364/2587-6821-2022-6-1-12-20
I.V. Fomin
Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
Changes in the profile of risk factors, the neglect of simple preventive measures and the use of low doses of medication lead to the appearance of numerous multimorbid patients. Each practitioner faces this issue, both at the start of drug selection and during treatment. The more difficult a patient is, the more difficult it is to select medications of choice. This translates into polypharmacy and reduced therapeutic effectiveness. The basic rule of multimorbid patient treatment is the use of the most studied, safe and strategically efficient agents to improve hemodynamic parameters and quality of life. Meanwhile, the most important goal (sometimes overlooked) is to improve the prognosis at each stage of multimorbidity. ACE inhibitors in optimal dosages with a maximum safety profile are preferred drugs in multimorbid patients. According to the U.S. Ambulatory Guidelines (2019) and KDIGO 2021, of the ACE inhibitors used in daily practice, fosinopril is the safest medication in multimorbid patients.
Keywords: ACE inhibitors, fosinopril, multimorbid patients, treatment, congestive heart failure.
For citation: Fomin I.V. ACE inhibitors in a multimorbid patient: focus on fosinopril. Russian Medical Inquiry. 2022;6(1):12–20 (in Russ.). DOI: 10.32364/2587-6821-2022-6-1-12-20.
About the author:
Igor V. Fomin — Dr. Sc. (Med.), Head of V.G. Vogralik Department of Hospital Therapy & General Medical Care, Privolzhsky Research Medical University; 10/1, Minin and Pozharsky sq., Nizhny Novgorod, 603950, Russian Federation; ORCID iD 0000-0003-0258-5279.
Contact information: Igor V. Fomin, e-mail: fomin-i@yandex.ru.
Financial Disclosure: the author has no a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 11.01.2022.
Revised 03.02.2022.
Accepted 01.03.2022.
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2. Salisbury C., Johnson L., Purdy S. et al. Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2011;61(582):e12–21. DOI: 10.3399/bjgp11X548929.
3. Cassell A., Edwards D., Harshfield A. et al. The epidemiology of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2018;68(669):e245–e251. DOI: 10.3399/bjgp18X695465.
4. Smith S.M., Wallace E., O’Dowd T., Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2016;3(3):CD006560. DOI: 10.1002/14651858.CD006560.pub3.
5. Violan C., Boreu Q.F., Mateo G.F. et al. Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies. PLoS ONE. 2014;9(7):e102149. DOI: 10.1371 / journal. pone. 010214.
6. Tarlovskaya E.I. Comorbidity and polymorbidity are a modern interpretation and urgent tasks facing the therapeutic community. Cardiologiia. 2018;58(9S):29–38 (in Russ.). DOI: 10.18087/cardio.256.
7. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G. et al. International register "Dynamics analysis of comorbidities in SARS-CoV-2 survivors" (AKTIV SARS-CoV-2): analysis of 1,000 patients. Russian Journal of Cardiology. 2020;25(11):4165 (in Russ.). DOI: 10.15829/29/1560-4071-2020-4165.
8. Richardson S., Hirsch J.S., Narasimhan M. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052–2059. DOI: 10.1001/jama.2020.6775.
9. Casas-Rojo J.M., Antón-Santos J.M., Millán-Núñez-Cortés J. et al. Clinical characteristics of patients hospitalized with COVID-19 in Spain: results from the SEMI-COVID-19 Registry. Rev Clin Esp (Barc). 2020;220(8):480–494. DOI: 10.1016/j.rce.2020.07.003.
10. SeyedAlinaghi S., Afsahi A.M., MohsseniPour M. et al. Late Complications of COVID-19; a Systematic Review of Current Evidence. Arch Acad Emerg Med. 2021;9(1):e14. DOI: 10.22037/aaem. v9i1.1058.
11. Klok F.A., Kruip M., van der Meer N.J.M. et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020;191:148–150. DOI: 10.1016/j.thromres.2020.04.041.
12. Fowler H., Belot A., Ellis L. et al. Comorbidity prevalence among cancer patients: a population-based cohort study of four cancers. BMC Cancer. 2020;20:2–15. DOI: 10.1186/s12885-019-6472-9.
13. Porta M.S., Greenland S., Last J.M. A dictionary of epidemiology: Oxford University press; 2014. (Electronic resource.) URL: www.oxfordreference.com/view/10.1093/acref/9780195314496.001.0001/acref-9780195314496-e-352?rskey=TmAWeL&result=351 (access date: 10.12.2021).
14. Leonova M.V., Steinberg L.L., Belousov Yu.B. et al. Results of pharmacoepidemiologic study of arterial hypertension PIFAGOR IV: physicians compliance. Russian Journal of Cardiology. 2015;1:59–66 (in Russ.). DOI: 10.15829/1560-4071-2015-1-59-66.
15. Polyakov D.S., Fomin I.V., Belenkov Yu.N. et al. Chronic heart failure in the Russian Federation: What has changed over 20 years of follow-up? Results of the EPOCHA-CHF study. Cardiologiia. 2021;61(4):4–14 (in Russ.). DOI: 10.18087/cardio.2021.4.n1628.
16. Levinson B., Sugarman A.A., Couchman T. et al. Advanced age per se no influence on the pharmacokinetics of the active diacid of fosinopril. J Clin Pharmacol. 1986;26:541–560.
17. Greenbaum R., Zucchelli P., Caspi A. et al. Comparison of the pharmacokinetics of fosinoprilat with enalaprilat and lisinopril in patients with congestive heart failure and chronic renal insufficiency. Br J Clin Pharmacol. 2000;49(1):23–31. DOI: 10.1046/j.1365-2125.2000.00103.x.
18. Lukela J.R., Van Harrison R., Jimbo M. et al. UMHS Chronic Kidney Disease Guideline, Guidelines for Clinical Care Ambulatory, July 2019. (Electronic resource.) URL: http://www.med.umich.edu/1info/FHP/practiceguides/kidney/CKD.pdf. (access date: 04.12.2021).
19. Hui K.K., Duchin K.L., Kripalani K.J. et al. Pharmacokinetics of fosinopril in patients with various degrees of renal function. Clin Pharmacol Ther. 1991;49:457–467.
20. Eknoyan G., Lameire N., Wheeler D.C. et al. KDIGO 2021 Clinical practice Guideline for the management of blood pressure in CKD. Kidney International. 2021;99:S1–S87.
21. Berdah J., Guest M., Salvador M. Study of the efficacy and safety of fosinopril in general practice in 19,435 hypertensive patients (FLIGHT Study). Ann Cardiol Angeiol (Paris). 1998;47(3):169–175. PMID: 9772944.
22. Vetter W. Treatment of senile hypertension: the Fosinopril in Old Patients Study (FOPS). Am J Hypertens. 1997;10(Pt2):255S–261S. DOI: 10.1016/s0895-7061(97)00332-4.
23. Dierck G.F., Janssen W.M., van Boven A.J. et al. Rationale, Design, and Baseline Characteristics of a Trial of Prevention of Cardiovascular and Renal Disease With Fosinopril and Pravastatin in Nonhypertensive, Nonhypercholesterolemic Subjects With Microalbuminuria (the Prevention of REnal and Vascular ENdstage Disease Intervention Trial [PREVEND IT]). Am J Cardiol. 2000;86(6):635–638. DOI: 10.1016/s0002-9149(00)01042-0.
24. Tatti P., Pahor M., Byington R.P. et al. Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care. 1998;21(4):597–603. DOI: 10.2337/diacare.21.4.597.
25. Marin R., Ruilope L.M., Aljama P. et al. A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease. J Hypertens. 2001;19(10):1871–1876. DOI: 10.1097/00004872-200110000-00023.
26. Zanchetti A., Crepaldi G., Bond M.G. et al. Different effects of antihypertensive regimens based on fosinopril or hydrochlorothiazide with or without lipid lowering by pravastatin on progression of asymptomatic carotid atherosclerosis: principal results of PHYLLIS--a randomized double-blind trial. Stroke. 2004;35(12):2807–2812. DOI: 10.1161/01.STR.0000147041.00840.59.
27. Borghi C., Marino P., Zardini P. et al. Post Acute Myocardial Infarction: The Fosinopril in Acute Myocardial Infarction Study (FAMIS). Am J Hypertens. 1997;10(S7):247S–254S. DOI: 10.1016/S0895-7061(97)00331-2.
28. Blumenthal M. Treatment of congestive heart failure: experience with fosinopril. Am J Hypertens. 1997;10(Pt2):289S–298S. DOI: 10.1016/s0895-7061(97)00336-1.
29. Erhardt L., Maclean A., Ilgenfritz J. et al. The Fosinopril Efficacy/Safety Trial (FEST) Study Group: Fosinopril attenuates clinical deterioration and improves exercise tolerance in patients with heart failure. Eur Heart J. 1995;16:1892–1899.
30. Bicket D.P. Using ACE inhibitors appropriately. Am Fam Physician. 2002;66(3):461–468. PMID: 12182524.
31. Rosolová H., Cech J., Sefrna F. Effectiveness and tolerance of fosinopril in the treatment of arterial hypertension of mild and medium severity. Vnitr Lek. 2001;47(12):834–839. PMID: 11826546.
32. Ferguson J.M., Minas J., Siapantas S. et al. Effects of a fixed-dose ACE inhibitor-diuretic combination on ambulatory blood pressure and arterial properties in isolated systolic hypertension. J Cardiovasc Pharmacol. 2008;51(6):590–595. DOI: 10.1097/FJC.0b013e31817a8316.
33. David D., Jallad N., Germino F.W. et al. A comparison of the cough profile of fosinopril and enalapril in hypertensive patients with a history of ACE inhibitor associated cough. Am J Ther. 1995;2:806–813.
34. Germino F.W., Lastra J., Pool P. et al: Evaluation of the cough profile of fosinopril in hypertensive patients with ACE inhibitor associated cough — A pilot study. Curr Ther Res. 1993;54:469–457.
35. Tong P.C., Ko G.T., Chan W.B. et al. The efficacy and tolerability of fosinopril in Chinese type 2 diabetic patients with moderate renal insufficiency. Diabetes Obes Metab. 2006;8(3):342–347. DOI: 10.1111/j.1463-1326.2005.00514.x.
36. Asselbergs F.W., Diercks G.F.H., Hillege H.L. et al. Effects of Fosinopril and Pravastatin on Cardiovascular Events in Subjects With Microalbuminuria. Circulation. 2004;110:2809–2816. DOI: 10.1161/01.CIR.0000146378.65439.7A.
37. Asselbergs F.W., Diercks G.F.H., Hillege H.L. et al. Elevated urinary albumin excretion complements the Framingham Risk Score for the prediction of cardiovascular risk — response to treatment in the PREVEND IT trial. IJC Heart & Vessels. 2014;4:193–197. DOI: 10.1016/j.ijchv.2014.04.004.
38. Brouwers F.P., Asselbergs F.W., Hillege H.L. et al. Long-term effects of fosinopril and pravastatin on cardiovascular events in subjects with microalbuminuria: ten years of follow-up of Prevention of Renal and Vascular End-stage Disease Intervention Trial (PREVEND IT). Am Heart J. 2011;161:1171–1178. DOI: 10.1016/j.ahj.2011.03.028.
39. Marin R., Ruilope L.M., Aljama P. et al. A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease. J Hypertens. 2001;19(10):1871–1876. DOI: 10.1097/00004872-200110000-00023.
40. Weir M.A., Fleet J.L., Dixon S.N. et al. Angiotensin Converting Enzyme Inhibitor Dialyzability and Outcomes in Older Patients Receiving Hemodialysis. Blood Purif. 2015;40(3):232–242. DOI: 10.1159/000438821.
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