Format

Send to

Choose Destination
ESC Heart Fail. 2018 Apr;5(2):354-363. doi: 10.1002/ehf2.12249. Epub 2018 Jan 17.

The impact of a dose of the angiotensin receptor blocker valsartan on post-myocardial infarction ventricular remodelling.

Author information

1
Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Busan, Republic of Korea.
2
Division of Cardiology, Department of Internal Medicine, Catholic University of Daegu, Daegu, Republic of Korea.
3
Division of Cardiology, Department of Internal Medicine, Dongkang Medical Center, Ulsan, Republic of Korea.
4
Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
5
Division of Cardiology, Department of Internal Medicine, Daedong Hospital, Busan, Republic of Korea.
6
Division of Cardiology, Department of Internal Medicine, Keimyung University Hospital, Daegu, Republic of Korea.
7
Division of Cardiology, Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea.
8
Division of Cardiology, Department of Internal Medicine, Sungkyunkwan University, Samsung Changwon Hospital, Changwon, Republic of Korea.
9
Division of Cardiology, Department of Internal Medicine, Busan National University Hospital, Busan, Republic of Korea.
10
Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea.
11
Division of Cardiology, Department of Internal Medicine, Gyeongsang University Hospital, Jinju, Republic of Korea.
12
Division of Cardiology, Daegu Fatima Hospital, Daegu, Republic of Korea.
13
Division of Cardiology, Bong Seong Memorial Hospital, Busan, Republic of Korea.

Abstract

AIMS:

Although clinical guidelines advocate the use of the highest tolerated dose of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after acute myocardial infarction (MI), the optimal dosing or the risk-benefit profile of different doses have not been fully identified.

METHODS AND RESULTS:

In this multicentre trial, 495 Korean patients with acute ST segment elevation MI and subnormal left ventricular (LV) ejection fraction (<50%) were randomly allocated (2:1) to receive maximal tolerated dose of valsartan (titrated up to 320 mg/day, n = 333) or low-dose valsartan (80 mg/day, n = 162) treatment. The primary objective was to assess the changes in echocardiographic parameters of LV remodelling from baseline to 12 months after discharge. After treatment, end-diastolic LV volume (LVEDV) decreased significantly in the low-dose group, but the difference in LVEDV changes was insignificant between the maximal-tolerated-dose and low-dose groups. End-systolic LV volume decreased significantly in both groups, to a similar degree between groups. LV ejection fraction rose significantly in both study groups, to a similar degree. Changes in plasma levels of neurohormones were also comparable between the two groups. Drug-related adverse effects occurred more frequently in the maximal-tolerated-dose group than in the low-dose group (7.96 vs. 0.69%, P < 0.001).

CONCLUSIONS:

In the present study, treatment with the maximal tolerated dose of valsartan did not exhibit a superior effect on post-MI LV remodelling compared with low-dose treatment and was associated with a greater frequency of adverse effect in Korean patients. Further study with a sufficient number of cases and statistical power is warranted to verify the findings of the present study.

KEYWORDS:

Dose; Myocardial infarction; Valsartan; Ventricular remodelling

PMID:
29341471
PMCID:
PMC5880661
DOI:
10.1002/ehf2.12249
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center