influence of chance. With 68.2% of the study population being male the results may not be representative of all patient groups. Beta blockers have a significant beneficial effect in the treatment of patients with chronic HF, especially in combination therapy with the ACE-i Enalapril. However, due to some limitations of the above trials the results obtained must be considered with caution, as it appears the full potential of Enalapril action was not realised due to poor patient selection. There is sufficient evidence to advocate the introduction of combination therapy with an ACE Inhibitor, followed by a beta blocker at the earliest opportunity and at the maximum tolerated dose. ACE-i vs ARB ACE-I Name Study Details Trial Drug ACE-I 1 N Primary Patient Trial Design Conclusions Name/Year Name 2 3 Outcomes characteristic P 1997 Losartan Captopril - - Total: 722 All well Randomised, Primary Losartan: dysfunction matched double-blind endpoint 352 clinical trial same in Captopril: both groups 370 [10.5%, p=n/a] ELITE II Losartan Captopril - - All-cause All well Randomised, No 2000 3,152 mortality matched double-blind significant Losartan: clinical trial differences 1,578 in primary Captopril: endpoint 1,574 [17.7% vs 15.9%, p=0.16] VALIANT Valsartan Captopril - - Total: All-cause All well Randomised, No 2003 14,703 mortality matched double-blind significant Captopril: clinical trial difference in 4,909 primary Valsartan: endpoint 4,909 [p=0.98] Both: 4,885 OPTIMAAL Losartan Captopril - - Total: All-cause very well Randomised, No 2002 5,477 mortality matched double-blind significant Losartan: clinical trial difference in 2,744 primary Captopril: endpoint 2,733 [p=0.069] Table 4. Summary of key trials comparing ACE-i and ARB therapies. (12,16,20,23) ARBs such as Losartan and Valsartan act by inhibiting the action of Ang-II on the heart, peripheral vasculature and kidney. In HF, they produce beneficial haemodynamic changes that are similar to the effects of ACE-i but are generally better tolerated. (2)
influence of chance. With 68.2% of the study population being male the results may not be representative of all patient groups. Beta blockers have a significant beneficial effect in the treatment of patients with chronic HF, especially in combination therapy with the ACE-i Enalapril. However, due to some limitations of the above trials the results obtained must be considered with caution, as it appears the full potential of Enalapril action was not realised due to poor patient selection. There is sufficient evidence to advocate the introduction of combination therapy with an ACE Inhibitor, followed by a beta blocker at the earliest opportunity and at the maximum tolerated dose. ACE-i vs ARB ACE-I Name Study Details Trial Name/Year Drug Name ACE-I 1 2 3 N Primary Outcomes Patient characteristic P Trial Design Conclusions 1997 Losartan Captopril - - Total: 722 Losartan: 352 Captopril: 370 dysfunction All well matched Randomised, double-blind clinical trial Primary endpoint same in both groups [10.5%, p=n/a] ELITE II 2000 Losartan Captopril - - 3,152 Losartan: 1,578 Captopril: 1,574 All-cause mortality All well matched Randomised, double-blind clinical trial No significant differences in primary endpoint [17.7% vs 15.9%, p=0.16] VALIANT 2003 Valsartan Captopril - - Total: 14,703 Captopril: 4,909 Valsartan: 4,909 Both: 4,885 All-cause mortality All well matched Randomised, double-blind clinical trial No significant difference in primary endpoint [p=0.98] OPTIMAAL 2002 Losartan Captopril - - Total: 5,477 Losartan: 2,744 Captopril: 2,733 All-cause mortality very well matched Randomised, double-blind clinical trial No significant difference in primary endpoint [p=0.069] Table 4. Summary of key trials comparing ACE-i and ARB therapies. (12,16,20,23) ARBs such as Losartan and Valsartan act by inhibiting the action of Ang-II on the heart, peripheral vasculature and kidney. In HF, they produce beneficial haemodynamic changes that are similar to the effects of ACE-i but are generally better tolerated. (2)