Copyright © 2003 by the European Society of Cardiology.
Clinical research
Comparative impact of enalapril, candesartan or metoprolol alone or in combination on ventricular remodelling in patients with congestive heart failure
a Hamilton Health Sciences, Hamilton, Ontario, Canada
b Toronto General Hospital, Toronto, Ontario, Canada
c Montreal Heart Institute, Montreal, Quebec, Canada
d The Cleveland Clinic Foundation, Cleveland, Ohio, USA
e Instituto di Recerche Farmacologiche, Milano, Italy
f AstraZeneca, AB, Mölndal, Sweden
* Correspondence to: Dr R. S. McKelvie, Hamilton Health Sciences, General Division, 237 Barton Street East, Hamilton, Ontario, Canada L8L 2X2. Tel: (905) 572-7155; fax: (905) 577-1480
E-mail address: mckelrob{at}hhsc.ca
Received 29 April 2003; revised 15 July 2003; accepted 31 July 2003
Abstract
Aims RESOLVD study patients were randomized to candesartan (C), enalapril (E), or C+E. Patients were later randomized to metoprolol CR (M) or placebo. Examine impact of C or E (C/E), C+E, C+M/E+M, C+E+M on ventricular remodelling in heart failure (HF) over 43 weeks.
Methods and results Four hundred and twenty-six of 768 patients receiving C, E, or C+E were randomized to either M or placebo. Patients were New York Heart Association class II–IV, ejection fraction (EF) <0.40 and 6-min walk distance <500m. Ejection fraction (EF), cardiac volumes, blood pressures, heart rates, and neurohormones were measured. End diastolic volumes changed +29.4±6.4ml for C/E, +16.6±10.4ml for C+E, +19.7±6.5ml for C+M/E+M, and –6.4±7.5ml for C+E+M (P
0.01). End systolic volumes changed +22.9±5.8ml for C/E, +11.9±9.1ml for C+E, +6.0±5.7ml for C+E/E+M, and –16.5±7.0ml for C+E+M (P0.001). Ejection fraction changed +0.01±0.01 for C/E, +0.01±0.01 for C+E, +0.03±0.01 for C+M/E+M, and +0.05±0.01 for C+E+M (P0.0001). No significant differences for blood pressure or neurohormones; heart rate for C+M/E+M and C+E+M decreased (P0.01) vs C/E or C+E.
Conclusion C+E+M had a modest but beneficial effect on cardiac function compared to the other groups. Combination of C+E+M has potential for providing HF patients with further benefit.
Key Words: Heart failure • Drugs • Cardiac volume • Blood pressure
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