Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study

Wong, Maylene; Staszewsky, Lidia; Latini, Roberto; Barlera, Simona; Volpi, Alberto; Chiang, Yann Tong; Benza, Raymond L.; Gottlieb, Sidney O.; Kleemann, Thomas; Rosconi, Franco; Vandervoort, Pieter M.; Cohn, Jay N.

doi:10.1016/s0735-1097(02)02063-6

Cited by 222 publications

(105 citation statements)

References 19 publications

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“…10,20,21 Thus, the vasodilatory effects of valsartan might have lowered arterial impedance in patients with the lowest SBP who would be expected to have the highest impedance, thereby increasing the cardiac output and maintaining blood pressure. Over the long term, valsartan use was associated with an improvement in LV ejection fraction 22 and a decrease in the levels of several neurohormones, including brain natriuretic peptide, norepinephrine, and aldosterone. 23,24 Thus, the dual effects of lowering impedance (BP-lowering effect) and improving LV structural remodeling might have contributed to the beneficial effects of valsartan on hemodynamics and subsequently to reduced morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Effect of Baseline and Changes in Systolic Blood Pressure Over Time on the Effectiveness of Valsartan in the Valsartan Heart Failure Trial

Anand

Rector

Kuskowski

et al. 2008

Circ: Heart Failure

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Background-Low systolic blood pressure (SBP) is a risk factor for adverse outcomes in patients with heart failure (HF).Valsartan improved morbidity rates in the Valsartan Heart Failure Trial (Val-HeFT) despite a reduction in SBP. The aim of the present study was to investigate the relationship between the SBP-lowering effects of valsartan and its cardiovascular protective effects in this population. Methods and Results-Baseline measurements and changes in SBP at 4 months were related to mortality and morbidity rates.The effects of valsartan on these end points were compared in quartiles of baseline SBP with multivariable Cox proportional hazards regression models that included a test for interaction between the effects of valsartan treatment and baseline SBP and examined the effects of changes in SBP on the valsartan effect. The meanϮSD baseline SBP in all patients (nϭ5010) Key Words: heart failure Ⅲ blood pressure Ⅲ clinical trial Ⅲ valsartan Ⅲ outcomes H igh blood pressure increases the risk of death in the general population, 1,2 and hypertension is the most important population-attributable risk factor for the development of heart failure (HF). 3,4 The benefits of treating hypertension on risks of major cardiovascular events are well established in the absence of systolic HF, and effective lowering of blood pressure is associated with an Ϸ50% reduction in the incidence of HF. 5,6 Once HF develops, however, lower blood pressure becomes a risk factor for increased mortality and morbidity rates both in acute decompensated 7,8 and chronic HF. 9 -11 The risk associated with elevated blood pressure in patients with systolic dysfunction has not been established. Vasodilators used in the treatment of hypertension, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and a combination of hydralazine and isosorbide, are also effective in reducing mortality and morbidity rates in patients with HF. [12][13][14][15][16][17] Whether the beneficial effects of these medications on morbidity and mortality rates in patients with HF are modified by initially low or drops in blood pressure is an important clinical issue. Clinical Perspective p 42The present study is a secondary analysis of the Valsartan Heart Failure Trial (Val-HeFT) database to study the effects of baseline blood pressure and changes in blood pressure over time on the effectiveness of treatment with valsartan on morbidity and mortality in patients with moderate to severe HF. First, we sought to confirm that both lower baseline systolic blood pressure (SBP) and a decrease in SBP over time were independently associated with an increased risk of morbidity and mortality. The interaction between the effects of valsartan and baseline SBP was then examined, controlling for several other known prognostic variables. Finally, to determine whether adjusting for any potentially deleterious drops in SBP during treatment would enhance the apparent beneficial effects of valsartan, we examined how controlling for changes in SBP affected the benef...

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Section: Discussionmentioning

confidence: 99%

Effect of Baseline and Changes in Systolic Blood Pressure Over Time on the Effectiveness of Valsartan in the Valsartan Heart Failure Trial

Anand

Rector

Kuskowski

et al. 2008

Circ: Heart Failure

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“…On the other hand, inotropic agents decreased %FS. The original large-scale trials indicated that beta-blockers [4], ACEI [5,6], or ARB [5,6] decreased both mortality and morbidity in patients with CHF, while inotropic agents increased mortality. Also, an increase in %FS [7], and a decrease in either plasma BNP level [8,9] or ventricular dimensions [10] are intermediate endpoints that predict the decrease in mortality and morbidity.…”

Section: Discussionmentioning

confidence: 99%

A Novel Data Mining Approach to the Identification of Effective Drugs or Combinations for Targeted Endpoints?Application to Chronic Heart Failure as a New Form of Evidence-based Medicine

Kim

Washio

Yamagishi

et al. 2004

Cardiovasc Drugs Ther

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“…5 To date, a number of chronic HF medications have been shown to improve LV remodeling including β-adrenergic blockers (BB), angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists. [6][7][8][9] Short of a single report, 5 however, little is known about the potential interplay between antiremodeling therapies and sST2 values in high-risk patients.…”

Section: Clinical Perspective On P 1213mentioning

confidence: 99%

Soluble Concentrations of the Interleukin Receptor Family Member ST2 and β-Blocker Therapy in Chronic Heart Failure

Gaggin

Motiwala

Bhardwaj

et al. 2013

Circ: Heart Failure

127

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Background-Concentrations of soluble (s)ST2 predict prognosis in heart failure. We recently found changing doses of β-blocker (BB) may affect sST2 concentrations. It remains unclear whether sST2 concentrations identify benefit of BB therapy, however. Methods and Results-A total of 151 subjects with heart failure attributable to left ventricular systolic dysfunction were examined in this post hoc analysis; >96% were taking BB at enrollment. Medication regimen and sST2 values were obtained during 10 months. Cardiovascular events were examined as a function of baseline sST2 status (low ≤35 versus high >35 ng/mL) and final achieved BB dose (high ≥50 versus low <50 mg daily equivalent dose of metoprolol succinate).Patients with low sST2 titrated to high-dose BB had the lowest cardiovascular event rate at 0.53 events (P=0.001), and lowest cumulative hazard (P=0.003). Those with low sST2/low-dose BB, or high sST2/high-dose BB had intermediate outcomes (0.92 and 1.19 events). Patients with high sST2 treated with low-dose BB had the highest cardiovascular event rate (2.08 events) and the highest cumulative hazard. Compared with low sST2/high-dose BB, those with high sST2 treated with low-dose BB had an odds ratio of 6.77 (P<0.001) for a cardiovascular event. Patients with low sST2/lowdose BB or high sST2/high-dose BB had intermediate odds ratios for cardiovascular events (P=0.18 and 0.02). Similar results were found for heart failure hospitalization and cardiovascular death. Conclusions-Although BB therapy exerted dose-related benefits across all study participants, sST2 measurement identifies patients with chronic heart failure who may particularly benefit from higher BB doses. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00351390.

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Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study

Abstract: The Val-HeFT echocardiographic substudy of 5,010 patients with moderate heart failure demonstrated that valsartan therapy taken with either ACEI or BB reversed LV remodeling.

Cited by 222 publications

References 19 publications

Effect of Baseline and Changes in Systolic Blood Pressure Over Time on the Effectiveness of Valsartan in the Valsartan Heart Failure Trial

Effect of Baseline and Changes in Systolic Blood Pressure Over Time on the Effectiveness of Valsartan in the Valsartan Heart Failure Trial

A Novel Data Mining Approach to the Identification of Effective Drugs or Combinations for Targeted Endpoints?Application to Chronic Heart Failure as a New Form of Evidence-based Medicine

Soluble Concentrations of the Interleukin Receptor Family Member ST2 and β-Blocker Therapy in Chronic Heart Failure

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