title: Randomised comparison of losartan vs. captopril on quality of life in elderly patients with symptomatic heart failure: the losartan heart failure ELITE quality of life substudy.
abstract: OBJECTIVE
  To measure health-related quality-of-life (HRQoL) in elderly symptomatic heart failure patients following treatment with an angiotensin II receptor antagonist (losartan) vs. an angiotensin-converting-enzyme (ACE) inhibitor (captopril).
  
  
  METHODS
  Patients (age > or = 65 years) were randomised to losartan, titrated to 50 mg once daily, or captopril, titrated to 50 mg three times daily, as tolerated. Sickness Impact Profile (SIP) and Minnesota Living with Heart Failure (LIhFE) questionnaires were administered at baseline, weeks 12 and 48. Composite hypothesis testing of change in HRQoL from baseline for completers, and withdrawal for unfavourable events (death, clinical/laboratory adverse experience) was used to account for differential dropout rates.
  
  
  RESULTS
  In 203 patients completing the substudy (week 48), significant and comparable improvements in HRQoL from baseline were observed for both treatment groups (p < or = 0.001). Although there was a trend favouring losartan vs. captopril for the composite HRQoL endpoint (unadjusted p = 0.018, one-sided), this was not considered significant after adjusting for multiple testing. Significantly more captopril patients in the substudy subset withdrew for unfavourable reasons (19.6 vs. 10.9%, p = 0.038).
  
  
  CONCLUSIONS
  Significant improvements in HRQoL were observed in elderly patients with symptomatic heart failure treated with losartan and captopril long-term. A trend favouring losartan in the composite measure of drug tolerability/quality of life was not significant, but losartan was generally better tolerated than captopril in that significantly fewer losartan patients discontinued therapy.
authors.affiliation: Queens Medical Centre-University Hospital, Nottingham, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Cowley
authors.forename: B L
authors.initials: BL
authors.lastname: Wiens
authors.forename: R
authors.initials: R
authors.lastname: Segal
authors.forename: M W
authors.initials: MW
authors.lastname: Rich
authors.forename: N C
authors.initials: NC
authors.lastname: Santanello
authors.forename: E J
authors.initials: EJ
authors.lastname: Dasbach
authors.forename: B
authors.initials: B
authors.lastname: Pitt
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D011788:Quality of Life
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D002216:Captopril; D019808:Losartan