What is the role of ARBs in the treatment of dilated cardiomyopathy?

Updated: Nov 28, 2018
  • Author: Vinh Q Nguyen, MD; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Answer

Data have demonstrated that angiotensin II receptor blockers (ARBs) are as effective as angiotensin-converting enzyme (ACE) inhibitors in the treatment of heart failure. Their adverse-effect profile is similar to that of ACE inhibitors with regard to renal insufficiency or hyperkalemia, but they do not cause potentiation of bradykinin and therefore do not cause cough.

ARB trials include the following:

  • Evaluation of Losartan in the Elderly (ELITE) (losartan vs captopril): Losartan was associated with lower mortality and was better tolerated [104]

  • Evaluation of Losartan in the Elderly II (ELITE II): Losartan was not superior to captopril in elderly patients with left ventricular dysfunction but was better tolerated [105]

  • Valsartan Heart Failure Trial (VALHeFT; valsartan vs placebo) in addition to standard therapy: Combined mortality and morbidity rates from heart failure decreased by 13.3% in patients receiving valsartan in addition to standard therapy

  • Candesartan in Heart failure-Assessment of moRtality and Morbidity in patients treated with ACE inhibitors (CHARMED–Added): In patients with a left ventricular ejection fraction (LVEF) below 40% and NYHA class II-IV symptoms already on an ACE-inhibitor, addition of candesartan reduced cardiovascular mortality and heart failure hospitalizations. [106] There were no differences in all-cause mortality. However, addition of candesartan was associated with higher rates of hyperkalemia and serum creatinine. [106]

  • Candesartan in Heart failure-Assessment of moRtality and Morbidity in patients intolerant to ACE inhibitors (CHARMED–Alternative): In patients with an LVEF below 40% and NYHA class II-IV heart failure with intolerance to ACE inhibitors, candesartan use led to a 20% reduction in cardiovascular death and a 40% reduction in hospitalization for heart failure. [107]

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