Morbidity, mortality, physiologic and functional parameters in elderly and non-elderly patients in the Valsartan Heart Failure Trial (Val-HeFT).
BACKGROUND
The Valsartan Heart Failure Trial (Val-HeFT) demonstrated the favorable effects of the addition of valsartan to prescribed heart failure (HF) therapy on HF hospitalization, and functional and physiological parameters. As the prevalence of HF morbidity and mortality are increased in the elderly, the effect of valsartan in the elderly is of clinical significance.


METHODS
In this post-hoc analysis, morbidity, mortality, left ventricular (LV) size and function, brain natriuretic peptide (BNP), aldosterone, norepinephrine (NE), quality of life, and treatment effect with valsartan were examined by subgroups of 2350 elderly (>or= 65 years) and 2660 non-elderly (< 65 years) patients enrolled in Val-HeFT.


RESULTS
While the overall incidence of morbidity and mortality was higher in the elderly, valsartan produced beneficial effects in reducing risk of morbidity in the elderly by 11.8% (P = .07), and the non-elderly by 14.6% (P = .09). Valsartan had no effect on mortality compared to placebo in the non-elderly, 15.2% vs 15.0% (P = .87), and elderly, 25.1% vs 24.0%, (P = .64). Valsartan had statistically significant beneficial effects in both the elderly and non-elderly on LV size and function, BNP, aldosterone and quality of life. Beneficial effects on NE were also observed with valsartan in both subgroups with statistically significant reductions produced in the non-elderly.


CONCLUSIONS
Val-HeFT demonstrated that elderly patients present with more advanced HF as evidenced by higher morbidity and mortality along with greater neurohormonal activation. In Val-HeFT, valsartan produced a consistent beneficial effect on morbidity, LV function and size, quality of life, and neurohormonal levels in both the elderly and non-elderly.
Baruch
Lawrence
L
Bronx VA Medical Center, Bronx, NY 10468, USA. baruchlarry@att.net <baruchlarry@att.net>
Glazer
Robert D
RD
Aknay
Nora
N
Vanhaecke
Johan
J
Heywood
J Thomas
JT
Anand
Inder
I
Krum
Henry
H
Hester
Allen
A
Cohn
Jay N
JN
D000328:Adult; D000367:Age Factors; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000378:metabolism; D011788:Quality of Life; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014633:Valine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000068756:Valsartan; D016277:Ventricular Function, Left
D047228:Angiotensin II Type 1 Receptor Blockers; D018377:Neurotransmitter Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine