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Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD pilot study investigators
Abstract
Background —We investigated the effects of candesartan (an angiotensin II antagonist) alone, enalapril alone, and their combination on exercise tolerance, ventricular function, quality of life (QOL), neurohormone levels, and tolerability in congestive heart failure (CHF). Methods and Results —Seven hundred sixty-eight patients in New York Heart Association functional class (NYHA-FC) II to IV with ejection fraction (EF) <0.40 and a 6-minute walk distance (6MWD) <500 m received either candesartan (4, 8, or 16 mg), candesartan (4 or 8 mg) plus 20 mg of enalapril, or 20 mg of enalapril for 43 weeks. There were no differences among groups with regard to 6MWD, NYHA-FC, or QOL. EF increased ( P =NS) more with candesartan-plus-enalapril therapy (0.025±0.004) than with candesartan alone (0.015±0.004) or enalapril alone(0.015±0.005). End-diastolic (EDV) and end-systolic (ESV) volumes increased less with combination therapy (EDV 8±4 mL; ESV 1±4 mL; P <0.01) than with candesartan alone (EDV 27±4 mL; ESV 18±3 mL) or enalapril alone (EDV 23±7 mL; ESV 14±6 mL). Blood pressure decreased with combination therapy (6±1/4±1 mm Hg) compared with candesartan or enalapril alone ( P <0.05). Aldosterone decreased ( P <0.05) with combination therapy (23.2±5.3 pg/mL) at 17 but not 43 weeks compared with candesartan (0.7±7.8 pg/mL) or enalapril (−0.8±11.3 pg/mL). Brain natriuretic peptide decreased with combination therapy (5.8±2.7 pmol/L; P <0.01) compared with candesartan (4.4±3.8 pmol/L) and enalapril alone (4.0±5.0 pmol/L). Conclusions —Candesartan alone was as effective, safe, and tolerable as enalapril. The combination of candesartan and enalapril was more beneficial for preventing left ventricular remodeling than either candesartan or enalapril alone.
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ACE inhibitors and ARBs have been shown to significantly improve adverse remodeling in heart failure patients.
“Furthermore, ACEis and ARBs have convincingly been shown to significantly improve adverse remodeling in HF patients (9–11).”
From Discontinuation of afterload-reducing drugs decreases left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy (2024) · cites this paper as [11]
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Research works printed but not linked: 15
- The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;326:1429–1435.
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Metadata
- Authors
- McKelvie, R. S., Yusuf, S., Pericak, D., Avezum, A., Burns, R. J., Probstfield, J., Tsuyuki, R. T., White, M., Rouleau, J., Latini, R., Maggioni, A., Young, J., & Pogue, J.
- Affiliations
- From Hamilton Health Sciences Corporation–General Division, and McMaster University, Hamilton, Ontario, Canada (R.S.M., S.Y., D.P., J. Pogue); Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (A.A.); Toronto Hospital–Western Division, Toronto, Ontario, Canada (R.J.B.); Fred Hutchinson Cancer Center, Seattle, Wash (J. Probstfield); University of Alberta Hospitals, Edmonton, Alberta, Canada (R.T.T.); Montreal Heart Institute, Montreal, Quebec, Canada (M.W., J.R.); Istituto di Ricerche...
- Venue
- Circulation
- Published
- 1999-09-07
- Volume
- 100
- Issue
- 10
- Pages
- 1056-1064
- ISSN
- 0009-7322
- 1524-4539
- Cited by
- 692
- References
- 0
- Language
- en
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