title: Comparative impact of enalapril, candesartan or metoprolol alone or in combination on ventricular remodelling in patients with congestive heart failure.
abstract: OBJECTIVE
  RESOLVD study patients were randomized to candesartan (C), enalapril (E), or C+E. Patients were later randomized to metoprolol CR (M) or placebo. Examine impact of C or E (C/E), C+E, C+M/E+M, C+E+M on ventricular remodelling in heart failure (HF) over 43 weeks.
  
  
  RESULTS
  Four hundred and twenty-six of 768 patients receiving C, E, or C+E were randomized to either M or placebo. Patients were New York Heart Association class II-IV, ejection fraction (EF) <0.40 and 6-min walk distance <500 m. Ejection fraction (EF), cardiac volumes, blood pressures, heart rates, and neurohormones were measured. End diastolic volumes changed +29.4+/-6.4 ml for C/E, +16.6+/-10.4 ml for C+E, +19.7+/-6.5 ml for C+M/E+M, and -6.4+/-7.5 ml for C+E+M (P< or =0.01). End systolic volumes changed +22.9+/-5.8 ml for C/E, +11.9+/-9.1 ml for C+E, +6.0+/-5.7 ml for C+E/E+M, and -16.5+/-7.0 ml for C+E+M (P< or =0.001). Ejection fraction changed +0.01+/-0.01 for C/E, +0.01+/-0.01 for C+E, +0.03+/-0.01 for C+M/E+M, and +0.05+/-0.01 for C+E+M (P< or =0.0001). No significant differences for blood pressure or neurohormones; heart rate for C+M/E+M and C+E+M decreased (P< or =0.01) vs C/E or C+E.
  
  
  CONCLUSIONS
  C+E+M had a modest but beneficial effect on cardiac function compared to the other groups. Combination of C+E+M has potential for providing HF patients with further benefit.
authors.affiliation: Hamilton Health Sciences, General Division, Ontario, Hamilton, Canada. mckelrob@hhsc.ca
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
authors.forename: Jean-Lucien
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.forename: Rizwan
authors.initials: R
authors.lastname: Afzal
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Peter
authors.initials: P
authors.lastname: Held
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000008:administration & dosage*; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects; D002306:Cardiac Volume / Q000187:drug effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage*; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects; D016019:Survival Analysis; D013777:Tetrazoles / Q000008:administration & dosage*; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; D004656:Enalapril; D008790:Metoprolol; C081643:candesartan