Effectsoflosartancomparedwithcaptoprilonmortality氯沙坦和卡托普利对死亡率的比较.pptVIP

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Effectsoflosartancomparedwithcaptoprilonmortality氯沙坦和卡托普利对死亡率的比较.ppt

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Effectsoflosartancomparedwithcaptoprilonmortality氯沙坦和卡托普利对死亡率的比较

Effects of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomized trial -- the Losartan Heart Failure Survival Study ELITE II Bertram Pitt, Philip A Poole-Wilson, Robert Segal, Felipe A Martinez, Kenneth Dickstein, A John Camm, Marvin A Konstam, Gunter Riegger, George H Klinger, James Neaton, Divakar Sharma, Balasamy Thiyagarajan on behalf of the ELITE II investigators Background ELITE IIStudy Design ELITE IIBaseline Characteristics ELITE IIEndpoint Results ELITE IIDiscussion In controlled clinical trials involving about 5000 patients, of whom 2800 received losartan, acute and sustained hemodynamic benefits with chronic dosing have been seen, as well as effects similar to enalapril on exercise duration. The ELITE II findings, together with previous experience in heart failure and the known pharmacology of losartan, make it probable that losartan resembles an ACE inhibitor in heart failure. It still remains to be established, however, whether angiotensin II antagonists are a fully effective substitute for ACE inhibitors in heart failure. ELITE IIDiscussion Losartan was not superior to captopril in improving survival in elderly heart-failure patients, but was significantly better tolerated. Based on extensive randomized, placebo-controlled observations, ACE inhibitors should be the initial treatment for heart failure, although angiotensin II receptor antagonists may be useful to block the renin angiotensin aldosterone system when ACE inhibitors are not tolerated. * Lancet 2000;355:1582-87 48-week ELITE Study: In 722 ACEI na?ve elderly patients with heart failure due to systolic left ventricular dysfunction comparing losartan to captopril: No difference in persistent rise in serum creatinine concentrations (primary endpoint) 46% reduction in all-cause mortality (17 vs 32 for losartan and captopril, respectively) 64% reduction in sudden death (5 vs 14 for losartan and captopril, respectively) Similar improvement