What question did this study set out to answer?

To evaluate whether combining an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin II receptor blocker (ARB) suppresses neurohumoral factors and improves physical activity and cardiac function more effectively than monotherapy in heart failure.

January 1, 2004Circulation JournalOpen Access

Rationale for the Use of Combination Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Therapy in Heart Failure

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Why the study?

Does combination therapy with an ACE inhibitor and an ARB improve clinical outcomes, physical activity, and neurohumoral factors compared to monotherapy in patients with mild-to-moderate heart failure?

Population

147 adults with stable mild-to-moderate chronic heart failure for at least 3 months, documented left…

Comparison

Combination therapy of an angiotensin-converting… vs Monotherapy with either an ACEI or an ARB at…

Design

RCT, Randomly assigned, Open-labeled

Follow-up

6 months

Authors

YYYoshio YasumuraHeart Failure / Cardiomyopathy KMKunio MiyatakeCardiac Imaging HOHiroshi OkamotoTohoku University

Discussion

Member takes

Implication

Combination ACEI/ARB improves symptoms and BNP versus monotherapy in mild HF; extends dual RAS blockade evidence from this RCT.

Key Points

To evaluate whether combining an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin II receptor blocker (ARB) suppresses neurohumoral factors and improves physical activity and cardiac function more effectively than monotherapy in heart failure.
Multicenter randomized trial conducted across 26 Japanese institutes involving 106 patients with mild-to-moderate congestive heart failure.
Participants were randomly assigned to receive either standard-dose combination therapy (ACEI plus ARB) or monotherapy (ACEI or ARB alone) for 6 months.
Outcomes evaluated included Specific Activity Scale (SAS) scores, New York Heart Association functional class, and plasma neurohumoral biomarkers including brain natriuretic peptide (BNP).
Combination therapy significantly improved physical capacity, increasing SAS scores from 4.5 ± 1.5 to 4.9 ± 1.5 (p<0.05), whereas monotherapy showed no significant change (4.5 ± 1.4 to 4.6 ± 1.4, NS).
Plasma BNP concentrations decreased significantly with combination therapy from 183 ± 163 to 135 ± 118 pg/ml (p<0.05), compared to a non-significant change with monotherapy (156 ± 157 to 151 ± 185 pg/ml, NS).

Structured PICO

Population

147 adults (≥18 years) with stable mild-to-moderate chronic heart failure for at least 3 months, documented left ventricular systolic dysfunction (LVEF ≤45%), and LV dilatation (LVDd ≥55mm). Mean age 65, 77-84% male, Japanese cohort (26 institutes).

Intervention

Combination therapy of an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin II receptor blocker (ARB) (e.g., enalapril and losartan) at standard Japanese doses for 6 months.

Comparator

Monotherapy with either an ACEI or an ARB at standard Japanese doses for 6 months.

Outcome

Composite of (1) cardiovascular death or hospitalization because of heart failure, (2) additional administration of diuretic and/or inotropic agent for worsening heart failure, and (3) withdrawal of the ACEI or ARB because of the development of hypotension or cough at 6 months.composite

In Japanese patients with mild-to-moderate heart failure, combining an ACE inhibitor and an ARB at standard local doses improved physical activity and reduced BNP levels more than monotherapy, though it increased the risk of hypotension.

Limitations

Inadequate doses of ACEI or ARB in the monotherapy group to completely suppress the RAAS compared to the combination therapy
Limited sample size

Cite This Study

Yasumura et al. (2004) studied this question.

synapsesocial.com/papers/6a8096561c96fcc8ad70354d https://doi.org/10.1253/circj.68.361

Topics

Heart failure HFrEF treatment

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Rationale for the Use of Combination Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Therapy in Heart Failure

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Rationale for the Use of Combination Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Therapy in Heart Failure

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

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