Losartan in the Therapy of Heart Failure Patients

The effects of losartan on myocardial remodeling and neurohumoral status were studied in 240 patients with congestive heart failure. The patients were randomized into 3 groups of 80 subjects. Each group continued to receive conventional therapy including the angiotensin-converting enzyme inhibitor enalapril. Group 1 was also given a placebo, groups 2 and 3 had losartan in doses of 25 mg and 50 mg daily, respectively. The course of treatment was 48 weeks. Cardiac function was assessed by B-mode and Doppler echocardiography. Plasma neurohormone levels were determined by radioimmunoassay. Losartan in a dose of 50 mg daily gave the best improvement in cardiac function and the most marked reduction in plasma levels of renin, angiotensin II, aldosterone, atrial natriuretic peptide, endothelin-1, and norepinephrine levels than the lower dose of losartan or placebo. The fall in cortisol and serotonin levels was similar in each group. These data demonstrate the dose-dependent effects of losartan and clarify its role in the treatment of congestive heart failure.

[Prospects of endothelial dysfunction reversion in patients with congestive heart failure]

The aim of the study was to investigate the effect of angiotensin-converting enzyme inhibitor enalapril and non-peptide blocker of AT1 receptors losartan on endothelial function of the shoulder artery in patients with congestive cardiac insufficiency. The examination covered 96 patients (mean age 46.71 +/- 4.13) with stable effort angina (functional class II-III) and circulatory insufficiency (NYHA functional class II-III) having end-diastolic left-ventricular volume > 160 ml, left ventricular ejection fraction < 35%, sinus rhythm, cardiothoracal index > 0.55 units. Patients with fibrillar tachyarrhythmia, high grade blocks, pacemaker migration, artificial pacemaker, myocardial infarction were not included in the trial. The patients were randomized into 3 groups 32 patients each. In addition to basic therapy patients of group 1 received long-acting nitrates, digoxin, aspirin and furosemide; group 2--enalapril in daily dose 10 mg; group 3--losartan in daily dose 25 mg. A course of treatment lasted 12 weeks. Endothelial function was assessed by high resolution echography, dopplerography performed before and after temporary occlusion of the shoulder artery and sublingual nitroglycerin. In patients with cardiac insufficiency, accelerated blood flow in the shoulder artery after its temporary occlusion promoted realization of the vasoconstrictory reaction. This was verified as endothelial dysfunction. In the course of the treatment all the patients achieved insignificant increase of the shoulder artery initial diameter. After sublingual intake of nitroglycerin vasodilation was also insignificant. 12-week enalapril and losartan prevented vasoconstriction in the shoulder artery in response to quicker circulation following arterial occlusion. However, higher maximal flow speed did not correspond to the increment in the artery diameter after the occlusion in any group. The flow-induced vasodilation was more pronounced in the enalapril group. Losartan group had a trend to an increase in the inner diameter of the shoulder artery. It is shown that enalapril and losartan in congestive cardiac insufficiency improves endothelium-dependent vasodilation caused by nitroglycerin. Enalapril demonstrated stronger ability than losartan to reverse endothelial dysfunction in patients with cardiac insufficiency resultant from ischemic heart disease.

[Losartan in therapy of chronic heart failure]

To evaluate effectiveness of nonpeptide angiotensin-2 subtype-1 receptor antagonist losartan in therapy of symptomatic congestive heart failure in patients with ischemic heart disease, 116 patients were examined at the age of 36-62 (mean age 50.6 +/- 4.22). They had angina pectoris of functional class II-III (according to CCS) and congestive heart failure of functional class II-III (according to NYHA). All the patients were randomized into two groups. 60 patients of group 1 received basic medication with nitrates, diuretic (on demand), digoxin and aspirin. 56 patients of group 2 received basic medication and losartan (cozaar, MSD, USA) in the dose 25 mg/day for 48 weeks. Echocardiographic monitoring of the treatment efficacy was made. The outcomes of the treatment evidence that losartan improves the patients' clinical status and heart failure functional class. For twelve weeks losartan reduced left ventricular and atrial dilation positively influencing the isometric inotropic indices. In 48 weeks losartan arrested progression of pathologic remodelling of the left ventricle and prevents depression of total myocardial contractility. Losartan's positive effect in restriction of negative evolution of cardiac failure manifests on the treatment week 3.

[Cardiac failure treatment with berlipril: effects on hemodynamics, neurohumoral status and activity of free radical lipid peroxidation]

AIM

To test the ability of ACE inhibitor berlipril to control neurohumoral hyperactivation and reestablish balance between oxidant and antioxidant systems in patients with ischemic heart disease (IHD) associated with heart failure (HF).

MATERIALS AND METHODS

145 patients (mean age 51.5 +/- 3.94 years) with IHD class II-III associated with circulatory insufficiency NYHA class II-III received berlipril for 6 weeks.

RESULTS

Berlipril treated patients exhibited decreased class of HF, improved left ventricular conductivity, attenuated neurohumoral stimulation, intensity of cell membrane peroxidation, increased plasmic pool of antioxidant enzyme systems.

CONCLUSION

6-week berlipril treatment promoted a pronounced improvement of neurohormonal profile of plasm and recovery of free radical lipid peroxidation which resulted in reduction of HF.

[Effect of renitek--an ACE inhibitor--versus cozaar--an angiotensin I receptors antagonists--on morphofunctional state of left ventricular myocardium in patients with symptomatic cardiac insufficiency]

128 patients treated by renitek or cozaar for ischemic heart disease of NYHA class II-III effort angina and circulation insufficiency were subjected to echocardiographic monitoring for 12 weeks. Both drugs have proved their effectiveness in relation to prevention and inhibition of progression of pathological remodelling of the myocardium. Renitek is superior to cozaar in improving total contractility and morphofunctional state of the left ventricular myocardium. Cozaar is more effective than renitek in improvement of left ventricular local contraction and relaxation.

[An amino acid metabolic complex in optimizing the cardiac hemodynamic characteristics of patients with ischemic heart disease]

On the basis of findings from examination of 82 patients with ischemic heart disease presenting with exertional angina, functional class II-III, aged 62-86 years, efficacy was studied of an amino acid metabolic complex consisting of glutamic acid and methionine combined with basic antianginal drugs and single basic therapy with nitrates and calcium antagonists. Criteria for efficacy were condition of central cardiohemodynamics and inotropic indices. Glutamic acid and methionine combined with basic agents were found to make for enhancement of contractile function of ischemized myocardium, with the left ventricular local contractility being improved against the background of reduction in postload.

[A comparison of the clinical efficacy of enalapril maleate analogs in patients with heart failure and ischemic heart disease]

The authors examined 68 patients aged from 42 to 68 years with ischemic heart disease without a history of myocardial infarction and with angina pectoris of exertion functional class 2-3 and circulatory insufficiency class 2 (according to NYHA criteria). The criteria serving as the reason for relating patients to the follow-up group were left-ventricular end-diastolic volume > 160 ml, ejection fraction < 30%, cardiothoracic index > 0.55, threshold power of endured loads within a range of 71.5 +/- 2.30 watt. After stabilization of the clinical status by means of basic therapy (nitrates, blockers of slow calcium channels, diuretics, antiaggregants), all patients were divided into two follow-up groups. The first group consisted of 36 patients who received renitec (10 mg/24 h), patients of group 2 were given enap in the same dose. The course of treatment lasted 12 weeks. The effectiveness of treatment was controlled by echocardiography according to the standard methods in M- and B-regimens. Analysis of the obtained data showed that within 12-day follow-up renitec demonstrated higher effectiveness and lesser incidence of side-effects than did enap given in the same dose.

[Relationship between activity of atrial natriuretic peptide and process of myocardial remodelling in patients with cardiac failure]

Echocardioscopy in M- and B-modes with measurement of routine parameters of central hemodynamics and thickness of carotid intimal-medial segment as well as radioimmunoassay of plasma concentrations of atrial natriuretic peptide (ANUP) were performed in 159 patients aged 42-63 years (17 healthy subjects and 142 patients with cardiac failure associated with ischemic heart disease and sinus rhythm, without history of myocardial infarction). The results were indicative of possible use of ANUP as a marker of initial cardiac insufficiency and a corrector of the disease prognosis.

[The optimization of the hemodynamic characteristics in patients with ischemic heart disease and circulatory failure by using a substrate-coenzyme complex]

On the basis of findings from evaluation of 65 patients with ischemic heart disease presenting with functional class II-III effort angina and FC II-III circulatory insufficiency (NYHA) a comparative assessment was carried out of efficacy of combined therapy involving basic antianginal agents and glucose-insulin-potassium mixture plus glutaminic acid versus solitary basic therapy. It has been shown that combined versus basic therapy is much more capable of restoring cardiohemodynamic interrelations. This was evidenced by a significant reduction of the postexercise level, improvement in the coordination of work of the arterial system, and augmentation of the left ventricular inotropic function.

[The use of the new cardioprotective agent thiotriazoline in the therapy of ischemic heart disease in older patients]

The effect of tiotriazolin on the efficiency of antianginal therapy in aged patients with cardiac disease CD is studied. Clinical tests, functional (ECG, electrocardiotopography, cardiohemodynamics, etc.) and biochemical (indices of lipid peroxidation activity) methods of control were used as criteria of the treatment efficiency. Tiotriazolin was found to increase significantly the efficiency of basic drugs for CD treatment in aged patients.