(Circulation. 2000;102:e1.)
© 2000 American Heart Association, Inc.
Circulation Electronic Pages |
From St Lukes Episcopal Hospital, Texas Heart Institute, and the University of Texas Medical School at Houston, Houston, Texas
| Introduction |
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| Congestive Heart Failure |
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The study: A large-scale multicenter (289 clinical sites in
46 countries) randomized, controlled trial of Losartan (an
angiotensin receptor blocker) in patients with heart
failure. A total of 3152 patients with class II to IV heart failure and
an EF
40% were randomized to captopril (50 mg TID, n=1574) or
Losartan (50 mg/d, n=1578). To qualify for the study, patients
could not have been on prior ACE inhibitor therapy
for
7 days. Patients were subsequently followed for a mean of 558
days. The primary endpoint of the study was all-cause mortality.
The results: There was no significant difference in all-cause mortality in the 2 groups (captopril 15.9%; losartan 17.7%). Mortality in both groups was approximately 11%/year. Sudden death tended to be slightly lower (but not significantly) in the captopril group. In analyses of various clinical subsets, patients on ß-blockers and patients with an EF>32% showed more benefit with captopril. There were also no significant differences between group in the composite of sudden death and resuscitated cardiac arrest, in hospitalization rates, and the composite of all cause mortality and hospitalization. Captopril patients were significantly more likely to withdraw from therapy (14.5% versus 9.4% with Losartan).
Summary: In contrast to the previous ELITE trial, the larger
scale ELITE II trial showed no
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