Comparison of losartan and captopril on heart failure-related outcomes and symptoms from the losartan heart failure survival study (ELITE II).
BACKGROUND
Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors improves outcomes and symptoms in patients with heart failure (HF). We compared effects of losartan to captopril on mortality, morbidity, and functional status for patients in the ELITE II study.


RESULTS
A total of 3152 patients, aged 60 years or older, with New York Heart Association (NYHA) classes II to IV HF and ejection fraction < or = 40% were assigned to receive losartan 50 mg once daily or captopril 50 mg 3 times daily. Outcome measures included all-cause and HF-related mortality, hospitalizations, and discontinuations; change in NYHA class; and quality of life (QoL). HF-related outcomes were not significantly different between therapies. Similar improvements from baseline (P < .01) in NYHA class were observed within both treatment groups. Among 1856 QoL participants, 1343 patients survived at least 1 year; the QoL for 1-year survivors improved in both treatment groups (P < .001 vs baseline) and did not differ between groups.


CONCLUSIONS
In ELITE II, the effects of losartan on HF-related outcomes, NYHA class, and QoL were not superior to those of captopril. Although angiotensin-converting enzyme inhibitors remain the treatment of choice for patients with HF, the similarity of the findings in the present analysis supports a role for angiotensin-receptor antagonists in this patient population.
Konstam
Marvin A
MA
Division of Cardiology, Tufts-New England Medical Center, Boston, MA 02111, USA. mkonstam@tufts-nemc.org
Neaton
James D
JD
Poole-Wilson
Philip A
PA
Pitt
Bertram
B
Segal
Robert
R
Sharma
Divakar
D
Dasbach
Erik J
EJ
Carides
George W
GW
Dickstein
Kenneth
K
Riegger
Günter
G
Camm
A John
AJ
Martinez
Felipe A
FA
Bradstreet
Deborah C
DC
Ikeda
Leila S
LS
Santoro
Emanuela P
EP
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D013534:Survival
D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril; D019808:Losartan