Key result
Losartan and captopril reduced systolic blood pressure by 4.8% (P=0.02) and 10.7% (P=0.007) respectively, with no substantial differences in haemodynamics or exercise capacity between groups.
Why the study?
Does losartan improve central and regional haemodynamics, neurohormones, and exercise capacity compared to captopril in elderly patients with symptomatic heart failure?
RCT (n=18)
double-blind
randomised
Does losartan improve central and regional haemodynamics, neurohormones, and exercise capacity compared to captopril in elderly patients with symptomatic heart failure?
In elderly patients with symptomatic heart failure, losartan and captopril demonstrate similar effects on haemodynamics, neurohormones, and exercise capacity.
Either agent suits elderly symptomatic HF; confirms ARB-ACEI equivalence on hemodynamics and exercise capacity.
BACKGROUND: The AT1 receptor antagonists differ from the angiotensin converting enzyme inhibitors by achieving a more complete blockade of angiotensin II's actions and by not affecting bradykinin metabolism. There is little information on whether this causes clinically significant differences in haemodynamics, neurohormones and exercise tolerance in heart failure. AIMS: To compare the effects of losartan and captopril upon central and regional haemodynamics, neurohormones and exercise capacity in heart failure. METHODS: In a double-blind, randomised trial 18 patients aged > or =65 years with symptomatic heart failure were allocated to treatment with losartan (10 patients) or captopril (eight patients). Patients underwent assessment at baseline, after the first dose, at 12 weeks and at 24 weeks. RESULTS: Systolic blood pressure fell by - 10.7% 1 h after captopril 6.25 mg (P = 0.007) and by - 4.8% 3 h after losartan 12.5 mg (P = 0.02). The blood pressure reduction was sustained with losartan at 12 and 24 weeks. Systemic vascular resistance fell acutely after captopril (-16.4%, P = 0.01). Captopril caused an acute and sustained rise in superior mesenteric artery blood flow (+ 22.9%, P = 0.04), and a slower rise in renal artery blood flow (+31.7%, P = 0.01). Losartan had no acute effects on regional haemodynamics but had increased superior mesenteric artery blood flow by 38.1% at 12 weeks (P = 0.02). There were no substantial differences between losartan and captopril, and no changes occurred in neurohormones or exercise capacity. CONCLUSION: No substantial differences were observed between losartan and captopril on central or regional haemodynamics, neurohormones or exercise capacity in elderly patients with stable symptomatic heart failure.
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Houghton et al. (1999) conducted an RCT in symptomatic heart failure (n=18). losartan vs. captopril was evaluated on central and regional haemodynamics, neurohormones and exercise capacity. Losartan and captopril reduced systolic blood pressure by 4.8% (P=0.02) and 10.7% (P=0.007) respectively, with no substantial differences in haemodynamics or exercise capacity between groups.