K Dickstein1. 1. University of Bergen, Central Hospital in Rogaland, Stavanger, Norway. trout@online.no
Abstract
BACKGROUND: Heart failure places a burden on patients and health care systems worldwide. Although the advent of angiotensin-converting enzyme (ACE) inhibitors markedly improved management of this chronic disorder, treatment is still not optimal, and morbidity and mortality remain high. OBJECTIVE: This review summarizes existing data on losartan, an angiotensin II (AII)-receptor antagonist, and compares its potential role with that of ACE inhibitors in the management of patients with heart failure. METHODS: Relevant primary studies and review articles were identified through a MEDLINE search of the English-language literature for the past 5 years and through examination of the reference lists of the articles so identified. Search terms included, but were not limited to, angiotensin-converting enzyme inhibitors, angiotensin II-receptor antagonists, and losartan. RESULTS: Preclinical and clinical studies of losartan have demonstrated consistent hemodynamic effects (via selective antagonism of the AII type 1 receptor) and a safety profile similar to that of placebo (presumably a reflection of the selective approach to AII blockade). In addition, large-scale end-point studies have shown losartan to have comparable efficacy to ACE inhibitors on a number of morbidity and mortality measures. CONCLUSIONS: There is strong evidence for the broad applicability of AII-antagonists in heart failure and for the use of AII-antagonists in the treatment of a broader population of patients with heart failure, not only those who are unable to tolerate treatment with ACE inhibitors.
BACKGROUND:Heart failure places a burden on patients and health care systems worldwide. Although the advent of angiotensin-converting enzyme (ACE) inhibitors markedly improved management of this chronic disorder, treatment is still not optimal, and morbidity and mortality remain high. OBJECTIVE: This review summarizes existing data on losartan, an angiotensin II (AII)-receptor antagonist, and compares its potential role with that of ACE inhibitors in the management of patients with heart failure. METHODS: Relevant primary studies and review articles were identified through a MEDLINE search of the English-language literature for the past 5 years and through examination of the reference lists of the articles so identified. Search terms included, but were not limited to, angiotensin-converting enzyme inhibitors, angiotensin II-receptor antagonists, and losartan. RESULTS: Preclinical and clinical studies of losartan have demonstrated consistent hemodynamic effects (via selective antagonism of the AII type 1 receptor) and a safety profile similar to that of placebo (presumably a reflection of the selective approach to AII blockade). In addition, large-scale end-point studies have shown losartan to have comparable efficacy to ACE inhibitors on a number of morbidity and mortality measures. CONCLUSIONS: There is strong evidence for the broad applicability of AII-antagonists in heart failure and for the use of AII-antagonists in the treatment of a broader population of patients with heart failure, not only those who are unable to tolerate treatment with ACE inhibitors.
Authors: Irving H Zucker; Harold D Schultz; Kaushik P Patel; Hanjun Wang Journal: Am J Physiol Heart Circ Physiol Date: 2015-02-13 Impact factor: 4.733