Clinical Trial Of Losartan In Treatment Of Chronic Congestive Heart Failure

1. BackgroundCongestive heart failure(CHF),One of the most common and complicated clinical syndromes, is characterized by the deficiency of cardiac output and the congestion in both pulmonary and general circulation consequently and then systemic ischemia and hypoxemia presented. The development of many cardiovascular diseases may be led to such a same ultimate sequence as CHF,such as coronary heart disease(CHD),hypertensive heart disease(HHD),dilated cardiomyopathy(DCM)and rheumatic heart disease(RHD).There are lots of pathogenic factors in the whole pathophysiological process of CHF. Over neuro-hormonal activation plays an important role in sustaining and developing of CHF. Angiotensin II is one of the most important neurohormone ,Which contributing to the developing of CHF. It is known that angiotensin-converting-enzyme inhibitors(ACEI)canbe used in the treatment of CHF,ACEI can reduce morbidity and mortality in patients with CHF. The exact clinical efficacy,safety,tolerance of angiotensin II type 1 receptor antagonists such as losartan is remain uncertain. To evaluate the efficacy ,safety and the tolerance of losartan,the first angiotensin II type 1 receptor antagonist in patients with CHF, We investigate the clinical efficacy , safety and tolerance of losartan versus captopril and the control group (traditional treatment group)in this study.2. Methods. 113 patients with chronic congestive heart failure, New York Heart Association(NYHA)class II -IV ,were randomly assigned to losartan group (groupA, n=44),captopril group (groupB, n=39),control group (groupC, n=30). In addition to the traditional treatment(glucoside,diuretic),the patients were treated with losartan 50mg once daily for 24 weeks in group A,the group B were treated with captopril 12.5mg three times daily for 24 weeks, the group C were treated with the traditional treatment for 24 weeks. Before and after the treatment, the clinical effect ,safety and tolerance of the three groups were investigated.3. Results3.1 Clinical efficacy rate(based on NYHA Class):group A' was 87.2%,while group B was 82.1%(there is notsignificant differences between group A and group B,P=0.141),while group C was 40%,group A was significant better than group C, it showed the significant differences (P=0.003).3.2 Determination of cardiac shape and function by echocardiography:with the datum of cardiac shape and function such as EF, LVDd, LA,;LVPWT, LVMI, group .A was significant better than B and C, P<0.05,it showed the significant differences.3.3 As to the X ray CTR(cardiac thorax ratio), HR(heart rate) and BP(blood pressure),the effects of group AandB were better then group C; group A and B were similar.3.4 side effects:groupA:B:C was 4.6%:17.9%:6.7%, There was the fewest side effects occuring in group A than B and C . Losartan even can reduces uric acid, the patients treated with losartan who discontinued study were significant fewer than the patients treated with captopril.4. conclusionIn this study losartan was improved effect in the treatment of CHF, resemble captopril, was significant better than control group. Losartan can better delay the ventrical remodeling than captopril and control group. It has less side effects, better tolerance and higher safety than captopril and control group.