PMID- 23187648
OWN - NLM
STAT- MEDLINE
DCOM- 20130527
LR  - 20151119
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 14
IP  - 12
DP  - 2012 Dec
TI  - Predicting adverse events during angiotensin receptor blocker treatment in heart 
      failure: results from the HEAAL trial.
PG  - 1401-9
LID - 10.1093/eurjhf/hfs145 [doi]
AB  - AIMS: In patients with heart failure and reduced left ventricular ejection 
      fraction (HFrEF), renin-angiotensin-aldosterone system blockade reduces morbidity 
      and mortality, but comes at an increased risk of adverse events (AEs). We 
      utilized the HEAAL trial data to identify predictors of the most frequent 
      investigator-reported AEs. METHODS AND RESULTS: The HEAAL trial investigated the 
      relationship between losartan dose and outcomes in patients with HFrEF. Cox 
      proportional hazards modelling was used to investigate predictors of AEs and 
      their association with subsequent outcomes. In multivariate analyses, kidney 
      impairment, hyperkalaemia, and hypotension were more likely to occur in older 
      patients (P < 0.01 for each), and those taking aldosterone blockers (P < 0.01 for 
      each). Entry levels of creatinine, potassium, and systolic blood pressure were 
      associated with their respective AEs (P < 0.001 for each). Diabetes, baseline 
      haemoglobin, and diuretic use were predictors (P < 0.05) of kidney impairment and 
      hyperkalaemia. Following AEs due to kidney impairment [hazard ratio (HR) 2.19, 
      95% confidence interval (CI) 1.91-2.50], hyperkalaemia (HR 1.53, 95% CI 
      1.27-1.85), and hypotension (HR 1.93, 95% CI 1.62-2.29), the risk of death 
      increased compared with patients who did not experience these AEs. CONCLUSION: 
      While the risk of severe AEs is low, patients with HFrEF can be identified who 
      are at increased risk during treatment with an angiotensin receptor blocker. AEs 
      are associated with excess mortality, and at-risk patients should be monitored 
      closely.
FAU - Kiernan, Michael S
AU  - Kiernan MS
AD  - Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
FAU - Wentworth, Deborah
AU  - Wentworth D
FAU - Francis, Gary
AU  - Francis G
FAU - Martinez, Felipe A
AU  - Martinez FA
FAU - Dickstein, Kenneth
AU  - Dickstein K
FAU - Komajda, Michel
AU  - Komajda M
FAU - Zannad, Faiez
AU  - Zannad F
FAU - Neaton, James D
AU  - Neaton JD
FAU - Konstam, Marvin A
AU  - Konstam MA
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
RN  - 0 (Angiotensin II Type 1 Receptor Blockers)
RN  - 0 (Biomarkers)
RN  - JMS50MPO89 (Losartan)
SB  - IM
CIN - Eur J Heart Fail. 2012 Dec;14(12):1319-21. PMID: 23159580
MH  - Aged
MH  - Angiotensin II Type 1 Receptor Blockers/administration & dosage/*adverse effects
MH  - Biomarkers/blood
MH  - Dose-Response Relationship, Drug
MH  - Double-Blind Method
MH  - Female
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Losartan/administration & dosage/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Proportional Hazards Models
MH  - Treatment Outcome
EDAT- 2012/11/29 06:00
MHDA- 2013/05/29 06:00
CRDT- 2012/11/29 06:00
PHST- 2012/11/29 06:00 [entrez]
PHST- 2012/11/29 06:00 [pubmed]
PHST- 2013/05/29 06:00 [medline]
AID - hfs145 [pii]
AID - 10.1093/eurjhf/hfs145 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2012 Dec;14(12):1401-9. doi: 10.1093/eurjhf/hfs145.