Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial.
We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure.



We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, and an ejection fraction <0.45 who were receiving an angiotensin-converting enzyme inhibitor. The patients were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention. ClinicalTrials.gov: NCT01857999.



We studied 10 patients in the losartan group and 11 patients in the placebo group. The patient characteristics were as follows: age 52.7 years, ejection fraction 21.3%, dobutamine infusion 8.5 mcg/kg.min, indexed systemic vascular resistance 1918.0 dynes.sec/cm(5).m(2), cardiac index 2.8 L/min.m(2), and B-type natriuretic peptide 1,403 pg/mL. After 7 days of intervention, there was a 37.4% reduction in the B-type natriuretic peptide levels in the losartan group compared with an 11.9% increase in the placebo group (mean difference, -49.1%; 95% confidence interval: -88.1 to -9.8%, p = 0.018). No significant difference was observed in the hemodynamic measurements.



Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence.
Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.
Marcelo E
ME
Ochiai
Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.
Euler C O
EC
Brancalhão
Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.
Raphael S N
RS
Puig
Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.
Kelly R N
KR
Vieira
Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.
Juliano N
JN
Cardoso
Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.
Múcio Tavares de
MT
Oliveira
Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.
Antonio C P
AC
Barretto
D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy; D004280:Dobutamine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D057911:Angiotensin Receptor Antagonists; D020097:Natriuretic Peptide, Brain; D004280:Dobutamine; D019808:Losartan