© 1999 European Society of Cardiology
Haemodynamic, neurohumoral and exercise effects of losartan vs. captopril in chronic heart failure: results of an ELITE trial substudy
Department of Cardiovascular Medicine D Floor, South Block University Hospital, Queen's Medical Centre Nottingham NG7 2UH, UK
* Corresponding author. Present address: Department of Cardiology, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. Tel.: +44-116-249-0490; fax: +44-116-258 4666. E-mail address: houghtons{at}talk21.com
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Abstract |
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Background: The AT1 receptor antagonists differ from the angiotensin converting enzyme inhibitors by achieving a more complete blockade of angiotensin II's actions and by not affecting bradykinin metabolism. There is little information on whether this causes clinically significant differences in haemodynamics, neurohormones and exercise tolerance in heart failure.
Aims: To compare the effects of losartan and captopril upon central and regional haemodynamics, neurohormones and exercise capacity in heart failure.
Methods: In a double-blind, randomised trial 18 patients aged 
65 years with symptomatic heart failure were allocated to treatment with losartan (10 patients) or captopril (eight patients). Patients underwent assessment at baseline, after the first dose, at 12 weeks and at 24 weeks.
Results: Systolic blood pressure fell by –10.7% 1 h after captopril 6.25 mg (P = 0.007) and by –4.8% 3 h after losartan 12.5 mg (P = 0.02). The blood pressure reduction was sustained with losartan at 12 and 24 weeks. Systemic vascular resistance fell acutely after captopril (–16.4%, P = 0.01). Captopril caused an acute and sustained rise in superior mesenteric artery blood flow (+22.9%, P = 0.04), and a slower rise in renal artery blood flow (+31.7%, P = 0.01). Losartan had no acute effects on regional haemodynamics but had increased superior mesenteric artery blood flow by 38.1% at 12 weeks (P = 0.02). There were no substantial differences between losartan and captopril, and no changes occurred in neurohormones or exercise capacity.
Conclusion: No substantial differences were observed between losartan and captopril on central or regional haemodynamics, neurohormones or exercise capacity in elderly patients with stable symptomatic heart failure.
Key Words: Losartan • Captopril • AT1 receptor antagonist • Heart failure • Haemodynamics • Neurohormones
Received March 16, 1999; Revised June 30, 1999; Accepted July 1, 1999
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