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Use of Valsartan in Post-Myocardial Infarction and Heart Failure Patients

University Health Network in Toronto, University of Toronto, Toronto, Canada, peter.liu{at}utoronto.ca

Aldo Maggioni

ANMCO Research Center, Florence, Italy

Eric J Velazquez

Duke University Medical Center, Durham, NC, USA

Left ventricular (LV) dysfunction and/or heart failure (HF) are frequent complications of hypertension and myocardial infarction (MI), placing affected patients at increased risk of significant morbidity and premature death. Given that the renin-angiotensin-aldosterone system (RAAS) is activated and of pathophysiological importance in such patients, a strong therapeutic rationale exists to target the main effector mechanism (that is, angiotensin II [Ang II]) in order to lessen the associated morbidity and mortality burden.

Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce mortality and LV dysfunction and to slow disease progression in patients with HF, including high-risk, post-MI patients. However, ACE inhibitors (ACE-Is) may not provide optimal long-term RAAS blockade (a finding that is associated with a worse prognosis) such and many patients are unable to tolerate such therapy (because of troublesome dry cough, for example). In contrast, Ang II receptor blockers (ARBs) may block the RAAS more completely than ACE-Is and appear to be better tolerated. Several large-scale trials have evaluated the efficacy of ARBs in patients with LV dysfunction and/or HF (including high-risk, post-MI patients), and have confirmed their utility as an R efficacious and well-tolerated alternative to ACE-Is in this setting.

Key Words: Valsartan • Hypertension • Heart failure • VALIANT trial • Val-HeFT trial

References

• Levy D., Larson MG, Vasan RS, Kannel WB, Ho KK The progression from hypertension to congestive heart failure. JAMA 1996;275:1557-62.[Abstract/Free Full Text]
• American Heart Association. Heart disease and stroke statistics - 2005 update. Dallas, Texas: American Heart Association, 2005.
• Velazquez EJ, Francis GS, Armstrong PW et al. An international perspective on heart failure and left ventricular systolic dysfunction complicating myocardial infarction: the VALIANT registry. Eur Heart J 2004;25:1911-19.[Abstract/Free Full Text]
• Packer M., Cohn JN, Abraham WT et al. Consensus recommendations for the management of chronic heart failure. Am J Cardiol 1999;83:1A-38A.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Hunt SA, Baker DW, Chin MH et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult. Executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2001;38:2101-13.[Free Full Text]
• Hunt SA, Baker DW, Chin MH et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. Available at http://www.acc.org/clinical/guidelines/failure/index.pdf
• Rouleau J-L., Packer M., Moyé L. et al. Prognostic value of neurohumoral activation in patients with an acute myocardial infarction: effect of captopril. J Am Coll Cardiol 1994; 24:583-91.[Abstract]
• Re RN Mechanisms of disease: local renin-angiotensinaldosterone systems and the pathogenesis and treatment of cardiovascular disease. Nat Clin Pract Cardiovasc Med 2004;1:42-7.[Web of Science][Medline] [Order article via Infotrieve]
• Unger T. Pharmacological properties of angiotensin II antagonists: examining all the therapeutic implications. JRAAS 2001;2(Suppl 2):S4-S7.
• Adams KJ Pathophysiological role of renin-angiotensinaldosterone system and sympathetic nervous system in heart failure. Am J Health-Sys Pharm 2004;61:S4-S13.[Abstract/Free Full Text]
• The CONSENSUS investigators. 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;316:1429-35.[Abstract]
• Flather MD, Yusuf S., Køber L. et al. for the ACE-Inhibitor Myocardial Infarction Collaborative Group. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet 2000;355:1575-81.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pfeffer MA, Braunwald E., Moye LA et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival And Ventricular Enlargement trial. N Engl J Med 1992;327:669-77.[Abstract]
• Roig E., Perez-Villa F., Morales M. et al. Clinical implications of increased plasma angiotensin II despite ACE inhibitor therapy in patients with congestive heart failure. Eur Heart J 2000;21:53-7.[Abstract/Free Full Text]
• Israili ZH, Hall WD Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy: a review of the literature and pathophysiology. Ann Intern Med 1992;117:234-42.[Abstract/Free Full Text]
• Weber KT, Villarreal D. Aldosterone and antialdosterone therapy in congestive heart failure. Am J Cardiol 1993; 71(Suppl):3A-11A.[Medline] [Order article via Infotrieve]
• Barr CS, Lang CC, Hanson J., Arnott M., Kennedy N., Struthers AD Effects of adding spironolactone to an angiotensin-converting enzyme inhibitor in chronic congestive heart failure secondary to coronary artery disease. Am J Cardiol 1995;76:1259-65.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pitt B., White H., Nicolau J. et al. Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 2005;46:425-31.[Abstract/Free Full Text]
• Pitt B., Williams G., Remme W. et al. The EPHESUS trial: eplerenone in patients with heart failure due to systolic dysfunction complicating acute myocardial infarction. Eplerenone Post-AMI Heart Failure Efficacy and Survival Study. Cardiovasc Drugs Ther 2001;15:79-87.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pfeffer MA, McMurray JJ, Velazquez EJ et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893-906.[Abstract/Free Full Text]
• Cohn JN, Tognoni G. for the Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001;345:1667-75.[Abstract/Free Full Text]
• Maggioni AP, Anand I., Gottlieb SO et al. Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors. J Am Coll Cardiol 2002;40:1414-21.[Abstract/Free Full Text]
• Maggioni IAP, Latini R., Carson PE et al. Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J 2005;149:548-57.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Wong M., Staszewsky L., Latini R. et al. Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study. J Am Coll Cardiol 2002;40:970-5.[Abstract/Free Full Text]
• Latini R., Masson S., Anand I. et al. Effects of valsartan on circulating brain natriuretic peptide and norepinephrine in symptomatic chronic heart failure: the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2002;106:2454-8.[Abstract/Free Full Text]
• McMurray JJ, Ostergren J., Swedberg K. et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003;362:767-71.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Kintscher U., Unger T. Vascular protection in diabetes: a pharmacological view of angiotensin II type 1 receptor blockers. Acta Diabetol 2005;42:S26-S32.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Nomura S., Shouzu A., Omoto S., Nishikawa M., Fukuhara S., Iwasaka T. Effect of valsartan on monocyte/endothelial cell activation markers and adiponectin in hypertensive patients with Type 2 diabetes mellitus. Thromb Res 2006; 117:385-92.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Yasunari K., Maeda K., Watanabe T., Nakamura M., Yoshikawa J., Asada A. Comparative effects of valsartan versus amlodipine on left ventricular mass and reactive oxygen species formation by monocytes in hypertensive patients with left ventricular hypertrophy. J Am Coll Cardiol 2004;43:2216-23.[Free Full Text]

Journal of Renin-Angiotensin-Aldosterone System, Vol. 7, No. 1 suppl, S19-S22 (2006)
DOI: 10.3317/jraas.2006.019


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Liu, P. P Articles by Velazquez, E. J Search for Related Content PubMed PubMed Citation Articles by Liu, P. P Articles by Velazquez, E. J Social Bookmarking                         What's this?