Objectives To investigate the efficacy and safety of fosinopril in the treatment of chronic heart failure (CHF), patients with mild to moderate CHF and left ventricular ejection fractions <40% were randomly assigned in a double-blind manner to receive fosinopril 5 to 20 mg every day (n = 122) or enalapril 5 to 20 mg every day (n = 132) for 1 year. Results The event-free survival time was longer (1.6 vs 1.0 months, P = .032) and the total rate of hospitalizations plus deaths was smaller with fosinopril than with enalapril (19.7% vs 25.0%, P = .028). There was consistently better symptom improvement with fosinopril (P < .05). The incidence of orthostatic hypotension was lower in the fosinopril group (1.6 % vs 7.6 %, P < .05). Conclusions Fosinopril 5 to 20 mg every day was more effective in improving symptoms and delaying events related to worsening of CHF and produced less orthostatic hypotension than enalapril 5 to 20 mg every day. (Am Heart J 1998;136:672-80.)