Safety And Efficacy Of The Combined Therapy Of Perindopril And Valsartan In Patients With Chronic Heart Failure

Obejective To investigate the efficacy and safety of the combined therapy of anangiotensin converting enzyme inhibitor(ACEI: perindopril) and an angiotensin IIreceptor blocker(ARB: valsartan) in patients with chronic heart failure(CHF).Toprovide feasible treatment strategies for clinicians and provide the scientific basis forevidence-based medicine for clinical drug therapy.Methods There were90patients with CHF in the first affiliated hospital ofHenan university of science and technology(63men and27women, aged45~88yearswith a mean±SD age of61.61±14.97years) from November2010to August2011.Each patient was receiving regular treatment(cardiac glycosides, diuretics and β-adrenocepter blockers) and randomly assigned to three groups: perindopril group(Pgroup), valsartan group(V group) or a combination of perindopril and valsartan(P+Vgroup) for24weeks. P group plus perindopril2~8mg/d, V group plusvalsartan40~80mg/d, and P+V group plus perindopril2~8mg/d andvalsartan40~80mg/d. Cardiac function(NYHA classification and6-min walkingdistance), echocardiographic findings, plasma N-termina pro-brain natriureticpeptide(NT-proBNP), heart rate(HR), blood pressure(SBP: systolic blood pressure andDBP: diastolic blood pressure), serum potassium(K+), blood urea nitrogen(BUN) andserum creatinine(Cr) levels were evaluated before and after the4-week,12-week,24-week therapy.Results1.(1)At24-week after treatment cardiac function improved significantly(p<0.05).After treatment, the P+V group heart function is significantly better than P group, Vgroup(p<0.05);(2)After the4-week,12-week and24-week therapy6-min walkingdistance improved significantly(p<0.05for each). Measuring time and group hadinteraction(F=8.014,p=0.000), and there was statistical significance among the threegroups(p<0.05). After the12-week and24-week therapy P+V group and P group, V group compared are statistically significant difference(p<0.05).Pairewise comparisonswere statistically significant(p=0.000for each) in the four-time tests.2.(1)After the4-week,12-week and24-week therapy LVED d, IVST d andLVPWT d were reduced(p<0.05for each). But there was no statistical significanceamong the three groups(p>0.05). Pairewise comparisons were statistically significant(p=0.000for each) in the four-time tests;(2)After the4-week,12-week and24-weektherapy LVMI(p<0.05for each) was reduced. Measuring time and group hadinteraction(F=10.329,p=0.000). There was statistical significance among the threegroups(F=3.226,p=0.045), and the percentage reduction in LVMI(p=0.016respectively)was greater in the P+V group than in V group. Pairewise comparisons werestatistically significant(p=0.000for each) in the four-time tests;(3)After the4-week,12-week and24-week therapy LVEF(p<0.05for each) increased. Measuring time andgroup had interaction(F=12.526,p=0.000). There was statistical significance among thethree groups(F=3.336,p=0.040), the percentage increasion in LVMI(p=0.034respectively) was greater in the P+V group than in the V group. Pairewise comparisonswere statistically significant(p=0.000for each) in the four-time tests;(4)At24-weekafter treatment plasma NT-proBNP was reduced(p<0.001for each). The percentagereduction in NT-proBNP(p<0.05for each) was greater in the P+V group than in eitherP or V group.3.After the4-week,12-week and24-week therapy, HR was reduced(p<0.05foreach). SBP and DBP were also reduced(p<0.05for each). But there was no statisticalsignificance among the three groups(p>0.05). Pairewise comparisons were statisticallysignificant(p=0.000for each) in the four-time tests.4.After the1-week,2-week,4-week,12-week and24-week therapy the K+level(p<0.05for each) increased in the normal rang. There was no statisticalsignificance among the three groups(F=0.673,p=0.509). Pairewise comparisons werestatistically significant(p=0.000for each) in the six-time tests, except for thecomparison between the1-week therapy and before, the2-week therapy and before.5.After the1-week,2-week,4-week,12-week and24-week therapy BUNlevel(p<0.05for each) increased. Measuring time and group had interaction(F=3.903,p=0.003), but there was no statistical significance among the threegroups(F=0.071,p=0.932). Pairewise comparisons were statistically significant(p=0.000for each) in the six-time tests.6.After the1-week,2-week,4-week,12-week and24-week therapy Cr level(p<0.05for each) increased. There was no statistical significance among the threegroups(F=1.678,p=0.193). Pairewise comparisons were statistically significant(p<0.05for each) in the six-time tests.Conclusions1.When compared with each monotherapy, perindopril and valsartancombination therapy exerts greater beneficial effects regarding improvement oncardiac function and increasion of6-min walking distance.2.When compared with each monotherapy, perindopril and valsartancombination therapy exerts greater beneficial effects regarding the regression of leftventricle remodeling, reduction in LVMI and NT-proBNP and increasion in LVEF in aselected group of patients with chronic heart failure.3.When compared with each monotherapy, perindopril and valsartancombination therapy has the same effect on reduction in heart rate, bloodpressure(SBP/DBP) and increasion of serum potassium, blood urea nitrogen and serumcreatinine. It’s safe, but it inqures monitoring closely.