PMID- 14680446
OWN - NLM
STAT- MEDLINE
DCOM- 20040407
LR  - 20211203
IS  - 1465-6566 (Print)
IS  - 1465-6566 (Linking)
VI  - 5
IP  - 1
DP  - 2004 Jan
TI  - Valsartan for the treatment of heart failure.
PG  - 181-93
AB  - Heart failure (HF) still has a discouraging prognosis. Therapeutic strategies aim 
      to reduce mortality as well as slow the progression of the disease, improve 
      symptoms and reduce the frequency of hospital admission. Activation of the 
      renin-angiotensin-aldosterone system (RAAS) is a hallmark of several 
      cardiocirculatory diseases, including HF. Drugs for evidence-based therapy of HF 
      are angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers and 
      aldosterone antagonists. A promising alternative is a more complete action on the 
      RAAS through selective blockade of the angiotensin type 1 (AT(1)) receptors, 
      taking into account not only physiopathological issues but also pharmacological, 
      experimental and clinical data. The effect of valsartan, an orally-active, 
      selective antagonist of AT(1) receptors, on the outcome in patients with chronic 
      and symptomatic HF was evaluated in a large-scale, international, 
      placebo-controlled clinical study, the Valsartan in Heart Failure Trial 
      (Val-HeFT). In this study, overall mortality was similar in the valsartan and 
      placebo groups (19.7 and 19.4%, respectively). However, valsartan, in addition to 
      recommended therapy of HF including an ACEI, significantly reduced the combined 
      end point of mortality and morbidity, with a significant reduction in the risk of 
      hospitalisation, paralleled by improvements in New York Heart Association (NYHA) 
      functional class, signs and symptoms and quality of life. Valsartan also improved 
      left ventricular anatomy and function and significantly reduced neurohormonal 
      activation. These results were confirmed and extended by the CHARM trial, where 
      the benefits of candesartan were proved not only in all 7599 patients with HF, 
      but also in the 2548 given an ACEI, the 2028 not given an ACEI and in the 3023 
      patients with an ejection fraction of > 40%. In conclusion, the first choice for 
      HF remains an ACEI with a beta-blocker, but two new options are emerging. In 
      patients intolerant to ACEI, the combination of valsartan or candesartan with a 
      beta-blocker is proposed, whereas an ACEI with either valsartan or candesartan 
      can be considered in patients intolerant to or with contraindications to 
      beta-blockers.
FAU - Latini, Roberto
AU  - Latini R
AD  - Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche, Mario 
      Negri, via Eritrea 62, 20157 Milan, Italy. latini@marionegri.it
FAU - Masson, Serge
AU  - Masson S
FAU - Staszewsky, Lidia
AU  - Staszewsky L
FAU - Maggioni, Aldo P
AU  - Maggioni AP
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
PL  - England
TA  - Expert Opin Pharmacother
JT  - Expert opinion on pharmacotherapy
JID - 100897346
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin II Type 1 Receptor Blockers)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Benzimidazoles)
RN  - 0 (Biphenyl Compounds)
RN  - 0 (Tetrazoles)
RN  - 80M03YXJ7I (Valsartan)
RN  - HG18B9YRS7 (Valine)
RN  - JMS50MPO89 (Losartan)
RN  - S8Q36MD2XX (candesartan)
SB  - IM
MH  - Adrenergic beta-Antagonists/pharmacology/therapeutic use
MH  - *Angiotensin II Type 1 Receptor Blockers
MH  - Angiotensin-Converting Enzyme Inhibitors/pharmacology/therapeutic use
MH  - Benzimidazoles/pharmacokinetics
MH  - Biphenyl Compounds
MH  - Clinical Trials as Topic
MH  - Drug Therapy, Combination
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Losartan/pharmacokinetics
MH  - Tetrazoles/pharmacokinetics/pharmacology/*therapeutic use
MH  - Treatment Outcome
MH  - Valine/analogs & derivatives/pharmacokinetics/pharmacology/*therapeutic use
MH  - Valsartan
RF  - 62
EDAT- 2003/12/19 05:00
MHDA- 2004/04/08 05:00
CRDT- 2003/12/19 05:00
PHST- 2003/12/19 05:00 [pubmed]
PHST- 2004/04/08 05:00 [medline]
PHST- 2003/12/19 05:00 [entrez]
AID - 10.1517/14656566.5.1.181 [doi]
PST - ppublish
SO  - Expert Opin Pharmacother. 2004 Jan;5(1):181-93. doi: 10.1517/14656566.5.1.181.