In the valsartan group, patients The upper limit of the one-sided Death from cardiovascular causes, reinfarction, or hospitalization for heart failure did not differ in the valsartan group The comparison of the valsartan group with the captopril group did meet the criteria for noninferiority for the composite endpoint of fatal and nonfatal cardiovascular events p Among patients with MI complicated by LV systolic dysfunction, heart failure, or both, treatment with valsartan, an ARB, alone or in combination with captopril, an ACE inhibitor, did not meet the primary endpoint of all-cause mortality compared with captopril monotherapy for superiority, but did meet the criteria for noninferiority.
The lack of improvement with combination therapy in the present trial is in contrast to the recent CHARM-Added trial, which showed a reduction in cardiovascular death or heart failure hospitalizations associated with combination therapy with the ARB candesartan and an ACE inhibitor in patients with heart failure. However, even in the CHARM-Added trial, there was an increase in study drug discontinuation due to adverse events of hypotension and increased creatinine.
N Engl J Med ; Presented by Dr. Marc A. Description: The goal of the trial was to evaluate the effect of the angiotensin-receptor blocker ARB valsartan, the angiotensin-converting enzyme ACE inhibitor captopril, and the combination of the two on mortality in patients with myocardial infarction MI complicated by left ventricular LV systolic dysfunction, heart failure, or both.
The combination of valsartan with captopril in this post-MI population was associated with a higher rate of adverse events without any further improvement in survival.
Discontinuations due to adverse events were least frequent in the valsartan-treated patients and most common among patients taking both agents.
The overall rate of treatment discontinuation was, however, similar in the captopril and valsartan groups. As expected, captopril monotherapy was more likely than valsartan therapy to be associated with cough, rash and taste disturbances.
Rates of hypotension and renal dysfunction were slightly higher in the valsartan group than in the captopril group. Implications for management Valsartan should now be considered as an alternative to ACE inhibitors in the treatment of post-MI patients. Looking to the future Other trials now in progress will provide additional information on the role of valsartan in reducing morbidity and mortality in early CVD. The Valsartan Antihypertensive Long-term Use Evaluation VALUE study is assessing time to mortality or a first nonfatal cardiac event in more than 15, high-risk patients with hypertension treated with valsartan or amlodipine.
Registered in the United Kingdom. This site is intended for health professionals only. Helapet launches new product datasheet look with new online archive Read more. Share this story:. Podcast: Self-management strategies in inflammatory arthritis. VLED and formula meal replacement diets best for weight loss in type 2 diabetes. Strong opiates no better than paracetamol and codeine for post-orthopaedic pain. Renin—angiotensin—aldosterone system inhibition Angiotensin II has many potentially damaging effects through its actions on the AT 1 receptor, including: Vasoconstriction.
Alteration of water and sodium homeostasis. Elevation of blood pressure BP. Promotion of atherosclerotic processes, including endothelial dysfunction and inflammation. Prothrombotic actions, including elevation of plasminogen activator inhibitor PAI -1 and promotion of platelet aggregation. Stimulation of smooth muscle cell proliferation. Vascular and myocardial remodelling. Am Heart J ; Eur J Heart Fail ; Pfeffer MA.
ACE inhibitors in acute myocardial infarction: patient selection and timing editorial. Circulation ; Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement Trial. N Engl J Med ; Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet ; A clinical trial of the angiotensin converting enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction.
Acute Infarction Ramipril Efficacy.
0コメント