Angiotensin II receptor blockers

Angiotensin II receptor blockers

The ELITE study is a randomised, double-blind controlled trial which was conducted to compare the influence of losartan and captopril on morbidity and mortality in older patients with CHF. This study involved 722 patients aged 65 or more with NYHA class II-IV CHF and left ventricular ejection fraction (LVEF) of 40% or less. It was demonstrated that losartan was better tolerated compared to captopril since there were fewer patients in the losartan group who discontinued treatment with the study drug due to intolerance to side effects. Furthermore, losartan also showed similar efficacy with captopril in reducing mortality and hospitalisations due to heart failure (p = 0.075).

The ELITE II losartan heart failure survival study is a further randomised, double-blind controlled trial which was conducted to evaluate the influence of losartan and captopril on mortality in patients with heart failure. This study involved 3152 patients aged 60 years or older with NYHA class II-IV heart failure and LVEF of 40% or less. Like in the ELITE study, losartan was better tolerated than captopril because there were significantly fewer patients in the losartan group who discontinued treatment with the study drug due to side effects (p < 0.001). Furthermore, losartan also showed similar efficacy with captopril in reducing mortality since there were no significant difference in the mortality rate between the two groups (p = 0.16).

A recent meta-analysis of data acquired from 17 relevant trials which involved 12,469 patients was conducted to evaluate the influence of ARBs on morbidity and mortality when used as a substitute or in addition to ACE inhibitors in the treatment of heart failure. In this meta-analysis, the use of ARBs showed similar efficacy with ACE inhibitors in reducing mortality (OR 0.96; 95% CI 0.75-1.23) and hospitalisations due to heart failure (OR 0.86; 95% CI 0.69-1.06).

A similar outcome was observed in a further meta-analysis of data acquired from 24 relevant trials which involved 38,080 patients which was conducted to evaluate the influence of ARBs on morbidity and mortality of patients with CHF and a high risk of acute myocardial infarction. It was shown that the use of ARBs led to a greater reduction in mortality and hospitalisations due to heart failure when compared to placebo. Moreover, ARBs also showed no significant difference with ACE inhibitors in reducing mortality and hospitalisations due to heart failure. Therefore, the use of ARBs as an alternative in patients who are intolerant to ACE inhibitors due to side effects appears to be promising.

The CHARM-Overall is a programme which consists of three randomised, double-blind clinical trials running in parallel to evaluate the effectiveness of candersartan in the treatment of heart failure in three different subgroups of patients. It was demonstrated that the use of candersartan resulted in significantly fewer cardiovascular deaths in the subgroup of patients with LVEF of 40% or less who were intolerant to ACE inhibitors when compared to placebo. Furthermore, the use of candersartan resulted in significantly fewer hospitalisations due to heart failure (p < 0.0001) in all three subgroups of patients. Candersartan also appears to be well tolerated during the programme since both groups showed similar number of patients who discontinued treatment with the study drug.

Diuretics

A recent meta-analysis of data acquired from 18 randomised controlled trials which involved 928 patients was conducted to evaluate the effectiveness of diuretics in the treatment of CHF. It was demonstrated that the use of diuretics resulted in an absolute risk reduction of 8% in mortality in patients who received diuretics compared to placebo. In addition, a number needed to treat of 12 was also acquired from this meta-analysis indicating that only 12 patients have to be treated will diuretics in order to prevent one patient from death due to heart failure. Furthermore, the use of diuretics also resulted in significant improvement in exercise capacity (OR 0.37; 95% CI 0.10-0.64) when compared to other conventional drugs that are used in the treatment of heart failure such as ACE inhibitor and digoxin.

A multicentre, open-label trial was conducted in 170 patients aged 35 to 85 with NYHA class II-III heart failure to evaluate the effectiveness and safety of torasemide in the treatment of CHF. It was demonstrated that

β-blockers

β-blockers should be considered in patients with all NYHA functional classes of HF unless since they have been shown to be effective in reducing morbidity and mortality associated with HF when used in combination with ACE inhibitors and diuretics in numerous controlled trials.

A randomised, double-blind controlled trial was conducted to evaluate the influence of carvedilol on mortality in patients with severe CHF. This trial involved 2289 patients with NYHA class III-IV heart failure who were randomly assigned to receive carvedilol or placebo in addition to their existing treatment. It was demonstrated that the addition of carvedilol led to a 35% reduction in the risk of mortality as well as a 24% reduction in the risk of hospitalisations.

A comparable outcome was observed in a further randomised, double-blind controlled trial involving 3391 patients with NYHA class II-IV heart failure and LVEF of 40% or less was conducted to evaluate the effect of modified-released preparations of metoprolol on morbidity and mortality in patients with heart failure. It was demonstrated that the use of metoprolol resulted in a significant decrease in the risk of mortality and hospitalisations due to heart failure. There were also more patients in the metoprolol with improved NYHA class status and quality of life.

Digoxin

Please be aware that the free essay that you were just reading was not written by us. This essay, and all of the others available to view on the website, were provided to us by students in exchange for services that we offer. This relationship helps our students to get an even better deal while also contributing to the biggest free essay resource in the UK!