Congestive Heart FailureSynergistic efficacy of enalapril and losartan on exercise performance and oxygen consumption at peak exercise in congestive heart failure☆
Section snippets
Study design and data acquisition
This was a double-blind, randomized, crossover, and placebo-controlled study. Figure 1 shows the study design. During a single-blind, placebo run-in period of 14 days, clinical stability was confirmed and patients’ characteristics were collected. A preliminary cardiopulmonary exercise test was performed for familiarization purposes, and the Minnesota living with heart failure quality-of-life questionnaire was filled out. Clinical stability was defined as unchanged New York Heart Association
Results
Two of the 20 patients who fulfilled the entry criteria were withdrawn from the study because of adverse reactions (hypotension with the drug combination, in 1 case, and cough while on enalapril, in the other case). They were excluded from the final analysis. The order of drug administration was uninfluential on the overall results, and data of each corresponding treatment step were pooled together independently of the sequence. The baseline characteristics of the patient population are listed
Discussion
In CHF, which causes exercise limitation (baseline peak VO2 was 13.4 ±4.0 ml/min/kg), a combination of losartan and enalapril yielded a better physical performance and exercise oxygen uptake compared with either drug alone. It also produced an additive inhibitory effect on plasma neurohormones, suggesting that neurohumoral modulation is more effective than with losartan or enalapril alone.
Cardiopulmonary exercise testing in CHF allows quantification of exercise intolerance, as well as
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This study was supported in part by a grant from the National Research Council, Rome, and the Monzino Foundation, Milan, Italy.