• NEENA KATOCH Department of Neuropsychopharmacology, Institute of Human Behaviour and Allied Health Sciences, New Delhi, India.
  • DINESH KUMAR BADYAL Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India.
  • RAJNEESH K CALTON Department of Cardiology, Christian Medical College, Ludhiana, Punjab, India.
  • NIKHIL KUMAR Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
  • GAURAV GULREZ Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India.


Objective: Renin–angiotensin–aldosterone system (RAAS) plays an important role in regulating post-myocardial infarction (post-MI) events. Ramipril and losartan act mainly by inhibiting RAAS. This study was designed to compare the efficacy and safety of ramipril against losartan in post-MI patients.

Methods: A total of 100 enrolled patients were divided into two groups A and B of 50 each by computer-generated random numbers. Group A (n=50) patients were given ramipril 1.25–2.5 mg once a day and Group B (n=50) patients were given losartan 25–50 mg once a day. The patients were followed after 0, 1, and 3 months and at 6 months (optional). Efficacy was compared based on the left ventricular ejection fraction (LVEF%) and New York Heart Association class improvement. Safety was compared by considering ADRs, mortality, and biochemical test profile. Data were analyzed using unpaired t-test and Chi-square test. p<0.05 was considered to be statistically significant.

Results: The mean LVEF% at 0 month for Group A was 40.6 ± 4.48 and for Group B was 39.6 ± 4.02 (p=0.212). The mean LVEF% at 6 months for Group A was 45.12 ± 4.6 and for Group B was 43.57 ± 4.03 (p=0.11). The most common side effects were headache in Group A and hypotension in Group B.

Conclusion: Both ramipril and losartan are equally efficacious; however, losartan has a better safety profile than ramipril.

Keywords: Left ventricular,, Remodeling,, Angiotensin.


1. Roger VL. Epidemiology of myocardial infarction. Med Clin North Am 2007;91:537-52.
2. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med 2016;4:256.
3. Writing Group Members, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, et al. Executive summary: Heart disease and stroke statistics 2016 update: A report from the American heart association. Circulation 2016;133:447-54.
4. Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Glob Health 2016;82:30-5.
5. Sezer M, Aslanger EK, Cimen AO, Yormaz E, Turkmen C, Umman B, et al. Concurrent microvascular and infarct remodeling after successful reperfusion of ST-elevation acute myocardial infarction. Circ Cardiovasc Interv 2010;3:208-15.
6. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. ACCF/AHA Guideline for the managementof ST-elevation myocardial infarction. J Am Coll Cardiol 2013;61:e78-140.
7. Gaudron P, Kugler I, Kai H, Bauer W, Eille C, Ertl G. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction. J Am Coll Cardio 2001;38:33-40.
8. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, et al. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of losartan in the elderly study, ELITE) Lancet 1997;349:747-52.
9. Dickstein K, Kjekshus J, OPTIMAAL Steering Committee of the OPTIMAAL Study Group. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: The OPTIMAAL randomised trial. Optimal trial in myocardial infarction with angiotensin II antagonist losartan. Lancet 2002;360:752-60.
10. Kumar M, Dahiya V, Mishra S, Sharma D, Mishra N, Lahkar M. Cardiovascular disease prevalence and drug utilisation pattern at a tertiary care hospital in North-eastern India. Int J Pharm Pharm Sci 2016;8:116-9.
11. Paranjape SG, Turankar AV, Wakode SL, Dakhale GN. Estrogen protection against coronary heart disease: Are the relevant effects of estrogen mediated through its effects on uterus such as the induction of menstruation, increased bleeding, and the facilitation of pregnancy? Med Hypotheses 2005;65:725-7.
12. Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative group on ACE inhibitor trials. JAMA 1995;273:1450-6.
13. Flather MD, Yusuf S, Køber L, Pfeffer M, Hall A, Murray G, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: A systematic overview of data from individual patients. ACE-inhibitor myocardial infarction collaborative group. Lancet 2000;355:1575-81.
14. Køber L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K, et al. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril cardiac evaluation (TRACE) study group. N Engl J Med 1995;333:1670-6.
15. Heart Outcomes Prevention Evaluation Study Investigators, Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-53.
16. Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893-906.
17. McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: The CHARM-added trial. Lancet 2003;362:767-71.
18. Winkelmayer WC, Fischer MA, Schneeweiss S, Levin R, Avorn J. Angiotensin inhibition after myocardial infarction: Does drug class matter? J Gen Intern Med 2006;21:1242-7.
19. Dicpinigaitis PV. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129:169S-73S.
20. Raebel MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Cardiovasc Ther 2012;30:e156-66.
21. Hameed J, Rutuparna P, Merin D, Abraham S, Thomas N. Assessment of clinical effectiveness of losartan and amlodipine in hypertensive patient with left ventricular hypertrophy. Asian J Pharm Clin Res 2017;10:368-71.
22. Kumar L. Pharmacovigilance/reporting adverse drug reactions: An approach to enhance health surveillance and extending market share by minimizing the chances of drug withdrawals. Int J Pharm Pharm Sci 2015;7:1-7.
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How to Cite
NEENA KATOCH, DINESH KUMAR BADYAL, RAJNEESH K CALTON, NIKHIL KUMAR, and GAURAV GULREZ. “TO COMPARE THE EFFICACY AND SAFETY OF RAMIPRIL VERSUS LOSARTAN IN POST-MYOCARDIAL INFARCTION PATIENTS”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 12, no. 6, Apr. 2019, pp. 115-8, doi:10.22159/ajpcr.2019.v12i6.32227.
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