Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial

Abstract

OBJECTIVE:We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure.METHODS:We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, and an ejection fraction <0.45 who were receiving an angiotensin-converting enzyme inhibitor. The patients were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention. ClinicalTrials.gov: NCT01857999.RESULTS:We studied 10 patients in the losartan group and 11 patients in the placebo group. The patient characteristics were as follows: age 52.7 years, ejection fraction 21.3%, dobutamine infusion 8.5 mcg/kg.min, indexed systemic vascular resistance 1918.0 dynes.sec/cm5.m2, cardiac index 2.8 L/min.m2, and B-type natriuretic peptide 1,403 pg/mL. After 7 days of intervention, there was a 37.4% reduction in the B-type natriuretic peptide levels in the losartan group compared with an 11.9% increase in the placebo group (mean difference, -49.1%; 95% confidence interval: -88.1 to -9.8%, p = 0.018). No significant difference was observed in the hemodynamic measurements.CONCLUSION:Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence.

Angiotensin receptor-neprilysin inhibition in patients with acute decompensated heart failure: an expert consensus position paper

“…Interestingly, only a small minority of the study patients (7.7%) required inotropes during hospitalization, possibly because of hypoperfusion or hypotension. Need for inotropes during hospitalization reflects a high-risk patient profile with an unfavorable prognosis [ 42 – 45 ], which may, however, benefit from neurohormonal axis inhibition [ 9 , 46 ]. As mentioned above, current guidelines strongly support the concept of continuation or initiation of the oral evidence-based HF-modifying therapies after hemodynamic stabilization for all the patients with AHF without any exception [ 10 ].…”

Study of superoxide- and NO-dependent protective mechanisms of N-acetylcysteine and losartan in ratʼs aorta and liver under streptozoticin-induced type 1 diabetes mellitus

“…The European Society of Cardiology (ESC Guidelines, 2013) have recommended the renin-angiotensinaldosterone system blockers, including angiotensin II (AT II) type 1 receptor blockers for patients with DM and decreased left ventricular ejection fraction [10]. In addition, cardioprotective properties of losartan (LOS) in patients with heart failure have been dynamically highlighted [11,12].…”