Comparison of angiotensin-converting enzyme inhibitor alone and in combination with irbesartan for the treatment of heart failure.
OBJECTIVE
Angiotensin-converting enzyme inhibitor (ACEI) is beneficial in patients with congestive heart failure (CHF). Some, but not all, angiotensin receptor blocker (ARB) was demonstrated to be effective as "add-on" therapy. We investigated whether irbesartan is useful as an add-on therapy in CHF.


METHODS
Randomized control trial.


METHODS
Single center.


METHODS
50 CHF patients on stable doses of ACEI.


METHODS
Add-on therapy with irbesartan (300 mg/day) or continuation of conventional therapy (control group) for 1 year.


METHODS
Serial clinical and echocardiographic assessment were performed as baseline, 3 months and 1 year after therapy.


RESULTS
There was no difference in clinical characteristics between 2 groups. Patients in the add-on therapy group had significant increase in 6-Minute Hall-Walk distance (351+/-89 to 392+/-84 m, P<0.01), achieved higher METs exercise time on treadmill test (3.9+/-1.1 to 4.6+/-1.3 METs, P=0.01), reduction of NYHA Class (2.4+/-0.5 to 2.0+/-0.8, P<0.005) and improvement of QOL score (28+/-19 to 17+/-18, P<0.05). These parameters were not improved in the control group and a worsening of exercise capacity was observed (P<0.05). A reduction of left ventricular end-systolic diameter (4.94+/-0.85 vs 4.30+/-1.17 cm, P<0.05) was observed in the add-on group. At the end of 1 year, more patients have normal or abnormal relaxation pattern in the add-on group than the control group (82% vs 53% chi(2)=7.1, P=0.02). Blood pressure and renal function were unchanged in both groups.


CONCLUSIONS
The addition of irbesartan to conventional ACEI therapy in CHF further improves symptoms, exercise capacity and quality of life without adverse effects on hemodynamics and renal function.
Kum
Leo Chi-Chiu
LC
Division of Cardiology, SH Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Yip
Gabriel Wai-Kwok
GW
Lee
Pui-Wai
PW
Lam
Yat-Yin
YY
Wu
Eugene B
EB
Chan
Anna Kin-Yin
AK
Fung
Jeffrey Wing-Hong
JW
Chan
Joseph Yat-Sun
JY
Zhang
Qing
Q
Kong
Shun-Ling
SL
Yu
Cheuk-Man
CM
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D003971:Diastole; D004359:Drug Therapy, Combination; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000077405:Irbesartan; D008297:Male; D011788:Quality of Life; D013318:Stroke Volume / Q000187:drug effects; D011795:Surveys and Questionnaires; D013599:Systole; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014463:Ultrasonography
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan