Cozaar vs. Zestril

  I have cardiomyopathy post Adriamycin cancer treatment.
  What a shock!! I am doing well. I am taking Cozaar(25mg) and Coreg(25mg bid). My concern is Cozaar may replace the coughing side effect with a serious increase in left ventricular wall thickness. Is it really true?
  My E.F. is 52%  From today I have stopped lanoxin. Is E.F. reliable in my situation who has been taking drugs? My E.F. was 50.40,38.
  Can I exercise (jogging)?
  Thanks
  Kim
    

[CCF Cardio MD - MTR]

Dear Kim, thank you for your question. Cozaar is known as an Angiotensin II Receptor
Blocker (A-II) and Zestril is an Angiotension Converting Enzyme Inhibitor (ACE-I).
We have very good information from many clinical studies that ACE-I improve survival and
clinical symptoms of heart failure in patients with congestive heart failure.  ACE-I
work by blocking the enzyme (ACE) that converts angiotensin to angiotensin II which
is a powerful constrictor of blood vessels and also block the breakdown of bradykinins
which is what causes the cough you describe.  A-II works by blocking the receptor for
angiotensin II but don't have any effect on bradykinins.  We have no good data on A-II
in CHF yet but trials are ongoing now.  Thus, we recommend that all patients with CHF
or a reduced E.F. be treated with ACE-I if they tolerate the side effects.  If not, then
Cozaar is a good alternative at this time.  Neither ACE-I nor A-II should increase
your LV wall thickness.  Both agents also decrease blood pressure which would reduce
LV wall thickness as BP is controlled.  E.F. is a relative assessment of left ventricular
function since the tests that measure E.F. are not highly accurate so we view E.F. as
more of an estimate than a hard fact.  However, it sounds reasonable to stop your lanoxin.
If you are not symptomatic at this time (i.e. - no shortness of breath, no fatigue) then
mild-moderate exercise would be very beneficial to you.  However, you should consult
your physician before embarking on an exercise program.  I hope you find this information
helpful.
Information provided in the heart forum is for general purposes only. Specific diagnoses
and therapies can only be provided by your physician.