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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

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.·1999·Circulation

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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Research works printed but not linked: 15

  1. 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.
  2. 10.1056/NEJM199108013250501 · DOI · Paper page
  3. 10.1016/0002-8703(88)90333-X · DOI
  4. 10.1161/circ.91.7.2043 · DOI
  5. Tsuyuki RT, Yusuf S, Rouleau JL, Maggioni A, McKelvie RS, Wiecek EW, Wang Y, Pogue J, Teo KK, White M, Avezum A, Latini R, Held P, Lindgren E, Probstfield J, for the RESOLVD Pilot Study Investigators. Combination neurohormonal blockade with ACE inhibitors, angiotensin II antagonists and beta-blockers in patients with congestive heart failure: design of the Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) Pilot Study. Can J Cardiol. 1997;13:1166–1174.
  6. 10.1016/0002-9149(93)90582-W · DOI
  7. 10.1016/0735-1097(95)80020-H · DOI
  8. 10.1016/S0735-1097(97)00253-2 · DOI
  9. 10.1016/S0140-6736(97)01187-2 · DOI
  10. 10.1097/00005344-199710000-00020 · DOI
  11. 10.1161/circ.96.7.2385 · DOI
  12. 10.1161/circ.82.5.2146040 · DOI
  13. 10.1161/circ.82.5.2225374 · DOI
  14. 10.1161/circ.91.3.691 · DOI
  15. Gottlieb SS Dickstein K Fleck E Kostis J Levine TB LeJemtel T Dekock M. Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure. Circulation. 1993;88(pt 1):1602–1609. · DOI

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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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