Congestive Heart FailureMeta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure☆
Section snippets
Selection of studies
A total of 8 clinical studies in the losartan heart failure program were available. Two of the 8 clinical studies in heart failure patients did not qualify for inclusion into the meta-analysis. One was a pharmacokinetic study, and the other was a single-dose study. No patients died during the course of these 2 studies. The remaining 6 studies were multicenter, randomized, double-blind studies, and had parallel treatment groups (Table I). These 6 studies were included in the meta-analysis,
Results
Baseline demographics and heart failure characteristics of patients enrolled in the losartan heart failure studies are presented in Table II. More men than women participated in all studies. The mean age of patients was ∼60 years, except for the ELITE trial, where age was >70 years. The studies were dominated by white patients, whereas the percentage of Hispanics was approximately 30% in 1 trial (Phase III-Int’l). More than half of all patients had coronary (ischemic) heart disease as the
Discussion
The meta-analysis method based on a combination of log ORs with a continuity correction was selected for this analysis. The OR is an approximation of the relative risk when event rates are low. To evaluate the robustness of the meta-analysis results, the data were also reanalyzed by Peto’s modification of the Mantel-Haenszel method.14 A significant mortality benefit was once again observed in favor of losartan and similar estimates of the overall ORs were observed. However, because the Peto
Acknowledgements
The authors would like to express their gratitude to all of the clinical investigators associated with the lorsartan heart failure studies, and Cindy White for designing the figures.
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2013, Journal of the American College of CardiologyCitation Excerpt :Class IIa ARBs are reasonable to reduce morbidity and mortality as alternatives to ACE inhibitors as first-line therapy for patients with HFrEF, especially for patients already taking ARBs for other indications, unless contraindicated (451–456). ( Level of Evidence: A)
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
2009, Journal of the American College of CardiologyCitation Excerpt :Experience with these drugs in controlled clinical trials of patients with HF is considerably less than that with ACEIs. Nevertheless, in several placebo-controlled studies, long-term therapy with ARBs produced hemodynamic, neurohormonal, and clinical effects consistent with those expected after interference with the renin angiotensin system (178–183). In patients with evidence of LV dysfunction early after MI, a recent trial demonstrated that ARBs had a benefit that was not inferior to that of ACEIs without an advantage in terms of tolerability (130).
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This study was supported by Merck Research Laboratories, West Point, Pennsylvania.
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A list of the study group investigators appears in the .