Rationale for the Use of Combination Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Therapy in Heart Failure

Yoshio Yasumura; Kunio Miyatake; Hiroshi Okamoto; Takeshi Miyauchi; Masatoshi Kawana; Takayoshi Tsutamoto; Masafumi Kitakaze; Hiroaki Matsubara; Hideyuki Takaoka; Teisuke Anzai; Hideo Himeno; Hiroyuki Yokoyama; Koichi Yokoya; Uichirou Shintani; Katsuji Hashimoto; Yukihiro Koretsune; Yukio Nakamura; Katsuji Imai; Shingo Maruyama; Yoshiko Masaoka; Michihito Sekiya; Teruo Shiraki; Hisanori Shinohara; Keizaburo Ozono; Tatsuru Matsuoka; Yuji Miyao; Fumikazu Nomura

doi:10.1253/circj.68.361

Clinical Investigation

Rationale for the Use of Combination Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Therapy in Heart Failure

Yoshio Yasumura, Kunio Miyatake, Hiroshi Okamoto, Takeshi Miyauchi, Masatoshi Kawana, Takayoshi Tsutamoto, Masafumi Kitakaze, Hiroaki Matsubara, Hideyuki Takaoka, Teisuke Anzai, Hideo Himeno, Hiroyuki Yokoyama, Koichi Yokoya, Uichirou Shintani, Katsuji Hashimoto, Yukihiro Koretsune, Yukio Nakamura, Katsuji Imai, Shingo Maruyama, Yoshiko Masaoka, Michihito Sekiya, Teruo Shiraki, Hisanori Shinohara, Keizaburo Ozono, Tatsuru Matsuoka, Yuji Miyao, Fumikazu Nomura

Author information

Yoshio Yasumura
The institutes particpating in the study are listed in Appendix 1
Kunio Miyatake
The institutes particpating in the study are listed in Appendix 1
Hiroshi Okamoto
The institutes particpating in the study are listed in Appendix 1
Takeshi Miyauchi
The institutes particpating in the study are listed in Appendix 1
Masatoshi Kawana
The institutes particpating in the study are listed in Appendix 1
Takayoshi Tsutamoto
The institutes particpating in the study are listed in Appendix 1
Masafumi Kitakaze
The institutes particpating in the study are listed in Appendix 1
Hiroaki Matsubara
The institutes particpating in the study are listed in Appendix 1
Hideyuki Takaoka
The institutes particpating in the study are listed in Appendix 1
Teisuke Anzai
The institutes particpating in the study are listed in Appendix 1
Hideo Himeno
The institutes particpating in the study are listed in Appendix 1
Hiroyuki Yokoyama
The institutes particpating in the study are listed in Appendix 1
Koichi Yokoya
The institutes particpating in the study are listed in Appendix 1
Uichirou Shintani
The institutes particpating in the study are listed in Appendix 1
Katsuji Hashimoto
The institutes particpating in the study are listed in Appendix 1
Yukihiro Koretsune
The institutes particpating in the study are listed in Appendix 1
Yukio Nakamura
The institutes particpating in the study are listed in Appendix 1
Katsuji Imai
The institutes particpating in the study are listed in Appendix 1
Shingo Maruyama
The institutes particpating in the study are listed in Appendix 1
Yoshiko Masaoka
The institutes particpating in the study are listed in Appendix 1
Michihito Sekiya
The institutes particpating in the study are listed in Appendix 1
Teruo Shiraki
The institutes particpating in the study are listed in Appendix 1
Hisanori Shinohara
The institutes particpating in the study are listed in Appendix 1
Keizaburo Ozono
The institutes particpating in the study are listed in Appendix 1
Tatsuru Matsuoka
The institutes particpating in the study are listed in Appendix 1
Yuji Miyao
The institutes particpating in the study are listed in Appendix 1
Fumikazu Nomura
The institutes particpating in the study are listed in Appendix 1

Keywords: Angiotensin converting enzyme inhibitor, Angiotensin II receptor blocker, Congestive heart failure

JOURNAL FREE ACCESS

2004 Volume 68 Issue 4 Pages 361-366

DOI https://doi.org/10.1253/circj.68.361

Details

Abstract

Background The present multicenter study investigated whether the combination of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) is more beneficial for preventing left ventricular remodeling and suppressing neurohumoral factors than either ACEI or ARB alone. Methods and Results One hundred and six patients with mild-to-moderate congestive heart failure treated in 26 Japanese institutes were randomly assigned to the combination therapy or monotherapy. Changes in physical activity (New York Heart Association functional classes, Specific Activity Scale (SAS)), concentrations of neurohumoral factors (plasma renin activity, angiotensin II, aldosterone, and brain natriuretic peptide (BNP)), and cardiac function for 6 months were compared between the 2 groups. It was found that the combination therapy, which was administered at doses standard in Japan, increased the SAS score (4.5±1.5 to 4.9±1.5, p<0.05) and decreased the plasma BNP concentration (183±163 to 135±118 pg/ml, p<0.05). In contrast, there were no changes in SAS score (4.5±1.4 to 4.6±1.4, NS) or BNP concentration (156±157 to 151±185 pg/ml, NS) in the patients receiving monotherapy. Conclusions The results of the study demonstrate that the combination therapy, even at the standard doses for Japan, improves physical activity and plasma BNP concentration more than the monotherapy. A larger study is required to assess the effects of the combination therapy on major clinical outcomes. (Circ J 2004; 68: 361 - 366)

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