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Clinical update: the role of angiotensin II receptor blockers in patients with left ventricular dysfunction (Part II

T Barry Levine1, Arlene B Levine

  • 1Division of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212-4772, USA. blevine@wpahs.org

Clinical Cardiology
|July 21, 2005
PubMed

Insights

Angiotensin II receptor blockers (ARBs) offer an alternative for heart failure (HF) patients intolerant to ACE inhibitors. Some ARBs, like candesartan, significantly reduce morbidity and mortality in HF patients, making them a strong consideration for treatment regimens.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Chronic heart failure (HF) affects nearly 5 million Americans, with increasing prevalence.
  • Angiotensin-converting enzyme (ACE) inhibitors are standard HF therapy but are not tolerated by over 10% of patients and may not provide long-term renin-angiotensin system (RAS) blockade.

Purpose of the Study:

  • To evaluate the role of angiotensin II receptor blockers (ARBs) in treating symptomatic HF and left ventricular systolic dysfunction.
  • To compare the efficacy and tolerability of ARBs against standard therapies or as add-on treatments.

Main Methods:

  • Review of large-scale clinical trials including ELITE II, Val-HeFT, and the CHARM program.
  • Analysis of morbidity and mortality data, hospitalizations, and drug interactions in HF patients treated with ARBs.

Main Results:

  • The ELITE II trial showed no significant difference between losartan (ARB) and captopril (ACE inhibitor) in elderly HF patients.
  • The Val-HeFT trial indicated that valsartan (ARB) reduced HF hospitalizations but not mortality when added to standard therapy.
  • The CHARM program demonstrated that candesartan (ARB) significantly reduced morbidity and mortality in HF patients with systolic dysfunction, irrespective of concomitant ACE inhibitor or beta-blocker use.

Conclusions:

  • ARBs may provide more complete RAS blockade than ACE inhibitors and are better tolerated.
  • ARBs are a viable treatment option for HF patients, particularly those intolerant to ACE inhibitors.
  • The addition of ARBs to existing HF treatment regimens should be strongly considered, especially candesartan, due to demonstrated benefits in morbidity and mortality.

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