(Circulation. 1999;99:990-992.)
© 1999 American Heart Association, Inc.
Brief Rapid Communication |
Addition of Angiotensin II Receptor Blockade to Maximal Angiotensin-Converting Enzyme Inhibition Improves Exercise Capacity in Patients With Severe Congestive Heart Failure
From the Departments of Medicine, Divisions of Cardiology, The Albert Einstein College of Medicine, Bronx, NY (G.H., I.B., R.B., R.P., S.T., T.H.L.); Columbia Presbyterian Medical Center, New York, NY (S.D.K., D.M.); Hôpital Ambroise Paré, Paris, France (G.J.); and the University of Nebraska Medical Center, Omaha (M.T.O.).
Correspondence to Thierry H. Le Jemtel, MD, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461.
Background—Incomplete suppression of the renin-angiotensin system during long-term ACE inhibition may contribute to symptomatic deterioration in patients with severe congestive heart failure (CHF). Combined angiotensin II type I (AT1) receptor blockade and ACE inhibition more completely suppresses the activated renin-angiotensin system than either intervention alone in sodium-depleted normal individuals. Whether AT1 receptor blockade with losartan improves exercise capacity in patients with severe CHF already treated with ACE inhibitors is unknown.
Methods and Results—Thirty-three patients with severe CHF despite
treatment with maximally recommended or tolerated doses of ACE
inhibitors were randomized 1:1 to receive 50 mg/d
losartan or placebo for 6 months in addition to standard
therapy in a multicenter, double-blind trial. Peak aerobic capacity
(
O2) during symptom-limited treadmill
exercise and NYHA functional class were determined at baseline and
after 3 and 6 months of double-blind therapy. Peak
O2 at baseline and after 3 and 6 months
were 13.5±0.6, 15.1±1.0, and 15.7±1.1 mL ·
kg-1 · min-1, respectively, in
patients receiving losartan and 14.1±0.6, 14.3±0.9, and
13.6±1.1 mL · kg-1 · min-1,
respectively, in patients receiving placebo (P<0.02 for
treatment group–by-time interaction). Functional class improved by at
least one NYHA class in 9 of 16 patients receiving losartan and
1 of 17 patients receiving placebo.
Conclusions—Losartan enhances peak exercise capacity and alleviates symptoms in patients with CHF who are severely symptomatic despite treatment with maximally recommended or tolerated doses of ACE inhibitors.
Key Words: angiotensin • heart failure • trials • exercise
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 Losartan Improves Exercise Capacity in CHF Patients Journal Watch Cardiology, April 16, 1999; 1999(416): 4 - 4. [Full Text]
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