title: Influence of Left Ventricular Ejection Fraction on the Effects of Supplemental Use of Angiotensin Receptor Blocker Olmesartan in Hypertensive Patients With Heart Failure.
abstract: BACKGROUND
  There is no robust evidence of pharmacological interventions to improve mortality in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) (HFpEF). In this subanalysis study of the SUPPORT Trial, we addressed the influence of LVEF on the effects of olmesartan in HF.
  
  
  RESULTS
  Among 1,147 patients enrolled in the SUPPORT Trial, we examined 429 patients with reduced LVEF (HFrEF, LVEF <50%) and 709 with HFpEF (LVEF ≥50%). During a median follow-up of 4.4 years, 21.9% and 12.5% patients died in the HFrEF and HFpEF groups, respectively. In HFrEF patients, the addition of olmesartan to the combination of angiotensin-converting enzyme inhibitor (ACEI) and β-blocker (BB) was associated with increased incidence of death (hazard ratio (HR) 2.26, P=0.002) and worsening renal function (HR 2.01, P=0.01), whereas its addition to ACEI or BB alone was not. In contrast, in HFpEF patients, the addition of olmesartan to BB alone was significantly associated with reduced mortality (HR 0.32, P=0.03), whereas with ACEIs alone or in combination with BB and ACEI was not. The linear mixed-effect model showed that in HFpEF, the urinary albumin/creatinine ratio was unaltered when BB were combined with olmesartan, but significantly increased when not combined with olmesartan (P=0.01).
  
  
  CONCLUSIONS
  LVEF substantially influences the effects of additive use of olmesartan, with beneficial effects noted when combined with BB in hypertensive HFpEF patients. (Circ J 2016; 80: 2155-2164).
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sakata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miyata
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shiba
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nochioka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takada
authors.forename: Chiharu
authors.initials: C
authors.lastname: Saga
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shinozaki
authors.forename: Masafumi
authors.initials: M
authors.lastname: Sugi
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Nobuyo
authors.initials: N
authors.lastname: Sekiguchi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Komaru
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Fukuchi
authors.forename: Eiji
authors.initials: E
authors.lastname: Nozaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hiramoto
authors.forename: Kanichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Goto
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Ohe
authors.forename: Kenji
authors.initials: K
authors.lastname: Tamaki
authors.forename: Setsuro
authors.initials: S
authors.lastname: Ibayashi
authors.forename: Nobumasa
authors.initials: N
authors.lastname: Ishide
authors.forename: Yukio
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
mesh_terms: D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000178:diet therapy / Q000401:mortality / Q000503:physiopathology; D007093:Imidazoles / Q000008:administration & dosage*; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects*; D015996:Survival Rate; D013777:Tetrazoles / Q000008:administration & dosage*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan