Comparison of angiotensin-converting enzyme inhibitor alone and in combination with irbesartan for the treatment of heart failure.

Abstract

OBJECTIVE:

Angiotensin-converting enzyme inhibitor (ACEI) is beneficial in patients with congestive heart failure (CHF). Some, but not all, angiotensin receptor blocker (ARB) was demonstrated to be effective as "add-on" therapy. We investigated whether irbesartan is useful as an add-on therapy in CHF.

DESIGN:

Randomized control trial.

SETTING:

Single center.

PATIENTS:

50 CHF patients on stable doses of ACEI.

INTERVENTIONS:

Add-on therapy with irbesartan (300 mg/day) or continuation of conventional therapy (control group) for 1 year.

MAIN OUTCOME MEASURES:

Serial clinical and echocardiographic assessment were performed as baseline, 3 months and 1 year after therapy.

RESULTS:

There was no difference in clinical characteristics between 2 groups. Patients in the add-on therapy group had significant increase in 6-Minute Hall-Walk distance (351+/-89 to 392+/-84 m, P<0.01), achieved higher METs exercise time on treadmill test (3.9+/-1.1 to 4.6+/-1.3 METs, P=0.01), reduction of NYHA Class (2.4+/-0.5 to 2.0+/-0.8, P<0.005) and improvement of QOL score (28+/-19 to 17+/-18, P<0.05). These parameters were not improved in the control group and a worsening of exercise capacity was observed (P<0.05). A reduction of left ventricular end-systolic diameter (4.94+/-0.85 vs 4.30+/-1.17 cm, P<0.05) was observed in the add-on group. At the end of 1 year, more patients have normal or abnormal relaxation pattern in the add-on group than the control group (82% vs 53% chi(2)=7.1, P=0.02). Blood pressure and renal function were unchanged in both groups.

CONCLUSION:

The addition of irbesartan to conventional ACEI therapy in CHF further improves symptoms, exercise capacity and quality of life without adverse effects on hemodynamics and renal function.

• Authors: Leo Chi-Chiu Kum, Gabriel Wai-Kwok Yip, Pui-Wai Lee, Yat-Yin Lam, Eugene B Wu, Anna Kin-Yin Chan, Jeffrey Wing-Hong Fung, Joseph Yat-Sun Chan, Qing Zhang, Shun-Ling Kong, Cheuk-Man Yu
• Journal: International journal of cardiology (Int J Cardiol) Vol. 125 Issue 1 Pg. 16-21 (Mar 28 2008) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 17433840 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Biphenyl Compounds
• Tetrazoles
• Irbesartan

Topics

• Aged
• Angiotensin II Type 1 Receptor Blockers (administration & dosage, therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage, therapeutic use)
• Biphenyl Compounds (administration & dosage, therapeutic use)
• Diastole
• Drug Therapy, Combination
• Exercise Tolerance
• Female
• Heart Failure (diagnostic imaging, drug therapy, physiopathology)
• Humans
• Irbesartan
• Male
• Quality of Life
• Stroke Volume (drug effects)
• Surveys and Questionnaires
• Systole
• Tetrazoles (administration & dosage, therapeutic use)
• Treatment Outcome
• Ultrasonography