Key result
Replacing an ACE inhibitor with an angiotensin II antagonist improved NYHA functional class and significantly decreased left ventricular dimension and BNP in patients with chronic heart failure.
Why the study?
Does replacing an ACE inhibitor with an angiotensin II antagonist improve left ventricular dimension, BNP, and NYHA class in patients with severe chronic heart failure?
Observational (n=11)
Does replacing an ACE inhibitor with an angiotensin II antagonist improve left ventricular dimension, BNP, and NYHA class in patients with severe chronic heart failure?
Replacing an ACE inhibitor with an ARB may improve symptoms and surrogate markers in heart failure patients with severe LV dysfunction or high natriuretic peptides despite ACEi and beta-blocker therapy.
OBJECTIVE: Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers improve prognosis inpatients with chronic heart failure. Some patients, however, show little response to combined treatment with an ACE inhibitor and a beta-blocker. In addition, the ACE inhibitor cannot completely suppress angiotensin II production. Our objective was to examine whether replacing the ACE inhibitor with an angiotensin II antagonist can improve the condition of patients with chronic heart failure. METHODS: In 11 patients with chronic heart failure treated with an ACE inhibitor and a beta-blocker, who have had severe left ventricular dysfunction or high plasma level of natriuretic peptides, left ventricular dimension, and fractional shortening, plasma atrial and brain natriuretic peptide (ANP and BNP) levels were determined before and 3 months after the change of treatment. RESULTS: After substituting the ACE inhibitor with an angiotensin II antagonist, patients showed New York Heart Association functional class improvement, and significant decrease in left ventricular dimension and BNP. CONCLUSION: In patients with severe chronic heart failure treated with an ACE inhibitor and a beta-blocker, replacing the ACE inhibitor with an angiotensin II antagonist may be effective. However, this has to be confirmed by an adequately powered randomized controlled study.
No takes yet. Share an insight, caveat, or question.
Hara et al. (2002) conducted an observational in chronic heart failure (n=11). Angiotensin II antagonist (replacing ACE inhibitor) vs. Baseline (ACE inhibitor therapy) was evaluated on NYHA functional class, left ventricular dimension, and plasma atrial and brain natriuretic peptide levels. Replacing an ACE inhibitor with an angiotensin II antagonist improved NYHA functional class and significantly decreased left ventricular dimension and BNP in patients with chronic heart failure.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: