title: [Angiotensin II receptor blocker add-on therapy for low cardiac output in decompensated heart failure].
abstract: BACKGROUND
  During heart failure (HF) decompensation, an intense activation of the renin-angiotensin-aldosterone system occurs; however, the use of angiotensin-converting enzyme inhibitor (ACEI) cannot block it completely. Otherwise, the addition of angiotensin II receptor blocker (ARB) can be useful when the inotropic dependence occurs. We evaluated the efficacy of the ARB-ACEI association on dobutamine withdrawal in advanced decompensated HF.
  
  
  OBJECTIVE
  To assess the efficacy of association angiotensin receptor blocker--angiotensin converting enzyme inhibitor to withdraw the intravenous inotropic support in decompensated severe heart failure.
  
  
  METHODS
  In a case-control study (N = 24), we selected patients admitted at the hospital due to HF that had been using dobutamine for more than 15 days, with one or more unsuccessful drug withdrawal attempts; optimized dose of ACEI and ejection fraction (EF) < 0.45. Then, the patients additionally received ARB (n=12) or not (control, n=12). The outcome was the successful dobutamine withdrawal, evaluated by logistic regression, with a p < 0.05.
  
  
  RESULTS
  The EF was 0.25 and the age was 53 years, with a dobutamine dose of 10.7 microg/kg x min. The successful drug withdrawal was observed in 8 patients from the ARB group (67.7%) and in 2 patients from the control group (16.7%). The odds ratio (OR) was 10.0 (95%CI: 1.4 to 69.3; p = 0.02). The worsening in renal function was similar (ARB group: 42% vs. control group: 67%; p=0.129).
  
  
  CONCLUSIONS
  In this pilot study, the ARB-ACEI association was associated with successful dobutamine withdrawal in advanced decompensated heart failure. The worsening in renal function was similar in both groups. Further studies are necessary to clarify the issue.
authors.affiliation: Hospital Auxiliar de Cotoxó do Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brasil. marcelo.ochiai@incor.usp.br
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Ochiai
authors.forename: Antonio C P
authors.initials: AC
authors.lastname: Barretto
authors.forename: Juliano N
authors.initials: JN
authors.lastname: Cardoso
authors.forename: Robinson T
authors.initials: RT
authors.lastname: Munhoz
authors.forename: Paulo C
authors.initials: PC
authors.lastname: Morgado
authors.forename: José A F
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000378:metabolism; D004280:Dobutamine / Q000009:adverse effects*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004280:Dobutamine