PMID- 9074572
OWN - NLM
STAT- MEDLINE
DCOM- 19970410
LR  - 20190611
IS  - 0140-6736 (Print)
IS  - 0140-6736 (Linking)
VI  - 349
IP  - 9054
DP  - 1997 Mar 15
TI  - Randomised trial of losartan versus captopril in patients over 65 with heart 
      failure (Evaluation of Losartan in the Elderly Study, ELITE).
PG  - 747-52
AB  - BACKGROUND: To determine whether specific angiotensin II receptor blockade with 
      losartan offers safety and efficacy advantages in the treatment of heart failure 
      over angiotensin-converting-enzyme (ACE) inhibition with captopril, the ELITE 
      study compared losartan with captopril in older heart-failure patients. METHODS: 
      We randomly assigned 722 ACE inhibitor naive patients (aged 65 years or more) 
      with New York Heart Association (NYHA) class II-IV heart failure and ejection 
      fractions of 40% or less to double-blind losartan (n = 352) titrated to 50 mg 
      once daily or captopril (n = 370) titrated to 50 mg three times daily, for 48 
      weeks. The primary endpoint was the tolerability measure of a persisting increase 
      in serum creatinine of 26.5 mumol/L or more (> or = 0.3 mg/dL) on therapy; the 
      secondary endpoint was the composite of death and/or hospital admission for heart 
      failure; and other efficacy measures were total mortality, admission for heart 
      failure, NYHA class, and admission for myocardial infarction or unstable angina. 
      FINDINGS: The frequency of persisting increases in serum creatinine was the same 
      in both groups (10.5%). Fewer losartan patients discontinued therapy for adverse 
      experiences (12.2% vs 20.8% for captopril, p = 0.002). No losartan-treated 
      patients discontinued due to cough compared with 14 in the captopril group. Death 
      and/or hospital admission for heart failure was recorded in 9.4% of the losartan 
      and 13.2% of the captopril patients (risk reduction 32% [95% CI -4% to + 55%], p 
      = 0.075). This risk reduction was primarily due to a decrease in all-cause 
      mortality (4.8% vs 8.7%; risk reduction 46% [95% CI 5-69%], p = 0.035). 
      Admissions with heart failure were the same in both groups (5.7%), as was 
      improvement in NYHA functional class from baseline. Admission to hospital for any 
      reason was less frequent with losartan than with captopril treatment (22.2% vs 
      29.7%). INTERPRETATION: In this study of elderly heart-failure patients, 
      treatment with losartan was associated with an unexpected lower mortality than 
      that found with captopril. Although there was no difference in renal dysfunction, 
      losartan was generally better tolerated than captopril and fewer patients 
      discontinued losartan therapy. A further trial, evaluating the effects of 
      losartan and captopril on mortality and morbidity in a larger number of patients 
      with heart failure, is in progress.
FAU - Pitt, B
AU  - Pitt B
AD  - Division of Cardiology, University Hospital, Ann Arbor, MI 48109-0366, USA.
FAU - Segal, R
AU  - Segal R
FAU - Martinez, F A
AU  - Martinez FA
FAU - Meurers, G
AU  - Meurers G
FAU - Cowley, A J
AU  - Cowley AJ
FAU - Thomas, I
AU  - Thomas I
FAU - Deedwania, P C
AU  - Deedwania PC
FAU - Ney, D E
AU  - Ney DE
FAU - Snavely, D B
AU  - Snavely DB
FAU - Chang, P I
AU  - Chang PI
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Lancet
JT  - Lancet (London, England)
JID - 2985213R
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Biphenyl Compounds)
RN  - 0 (Imidazoles)
RN  - 0 (Tetrazoles)
RN  - 9G64RSX1XD (Captopril)
RN  - AYI8EX34EU (Creatinine)
RN  - JMS50MPO89 (Losartan)
SB  - IM
CIN - ACP J Club. 1997 Sep-Oct;127(2):29
CIN - Lancet. 1997 May 17;349(9063):1473; author reply 1475. PMID: 9164335
CIN - Lancet. 1997 May 17;349(9063):1473-4; author reply 1475. PMID: 9164336
CIN - Lancet. 1997 May 17;349(9063):1474; author reply 1475. PMID: 9164337
CIN - Lancet. 1997 May 17;349(9063):1474; author reply 1475. PMID: 9164338
CIN - Lancet. 2000 Sep 2;356(9232):851-2; author reply 852-3. PMID: 11022948
CIN - Lancet. 2000 Sep 2;356(9232):852; author reply 852-3. PMID: 11022949
CIN - Lancet. 2003 Mar 8;361(9360):877-8; author reply 878. PMID: 12642072
MH  - Aged
MH  - *Angiotensin Receptor Antagonists
MH  - Angiotensin-Converting Enzyme Inhibitors/adverse effects/*therapeutic use
MH  - Biphenyl Compounds/adverse effects/*therapeutic use
MH  - Captopril/adverse effects/*therapeutic use
MH  - Creatinine/blood
MH  - Double-Blind Method
MH  - Female
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Hospitalization
MH  - Humans
MH  - Imidazoles/adverse effects/*therapeutic use
MH  - Kidney/drug effects
MH  - Losartan
MH  - Male
MH  - Mortality
MH  - Prospective Studies
MH  - Stroke Volume
MH  - Survival Analysis
MH  - Tetrazoles/adverse effects/*therapeutic use
EDAT- 1997/03/15 00:00
MHDA- 1997/03/15 00:01
CRDT- 1997/03/15 00:00
PHST- 1997/03/15 00:00 [pubmed]
PHST- 1997/03/15 00:01 [medline]
PHST- 1997/03/15 00:00 [entrez]
AID - S0140673697011872 [pii]
AID - 10.1016/s0140-6736(97)01187-2 [doi]
PST - ppublish
SO  - Lancet. 1997 Mar 15;349(9054):747-52. doi: 10.1016/s0140-6736(97)01187-2.