Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II

Pitt, Bertram; Poole‐Wilson, Philip A.; Segal, Robert; Martínez, Felipe A.; Dickstein, Kenneth; Camm, A. John; Konstam, Marvin A.; Riegger, Günter A.J.; Klinger, George; Neaton, James D.; Sharma, Divakar; Thiyagarajan, Balasamy

doi:10.1016/s0140-6736(00)02213-3

Cited by 1,727 publications

(874 citation statements)

References 32 publications

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“…Several large clinical trials have clearly shown that ACE inhibitors [5] and angiotensin receptor blockers (ARBs) [6] improve survival in patients with CHF compared to placebo. In a head-to-head comparison, the improvement in survival in patients with CHF was comparable between losartan, an ARB, and captopril, an ACE inhibitor [7]. In a subgroup analysis, the results were similar in women and men.…”

Section: Introductionmentioning

confidence: 80%

“…In the RESOLVD [18] study, there was a trend towards better survival with enalapril compared to candesartan (20/327 (6.1%) deaths in the candesartan group compared to 4/109 (3.7%) in the enalapril group, odds ratio 1.71, 95% confidence interval 0.57, 5.12). ELITE II [7], the largest study to date comparing ACE inhibitors and ARBs in CHF using mortality as the primary endpoint, found that the two classes of drugs were similar in their reduction of mortality (hazard ratio comparing losartan to captopril 1.13, 95% confidence interval 0.95, 1.35). The findings of ELITE II were recently confirmed in a large meta-analysis comparing ARBs to ACE inhibitors (odds ratio for all-cause mortality 1.06, 95% confidence interval 0.90, 1.26) [6].…”

Section: Discussionmentioning

confidence: 99%

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Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Hudson

Rahme

Behlouli

et al. 2007

European J of Heart Fail

100

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Background: Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to improve survival in patients with congestive heart failure (CHF). We wish to determine whether there are sex-related differences in the optimal treatment of congestive heart failure. Methods: Using administrative databases, all patients N >= 65 years of age discharged with a diagnosis of CHF between January 1998 and March 2003 and who filled a prescription for an ARB or an ACE inhibitor within 90 days of discharge were identified. Time to all-cause death in women and men on ACE inhibitors or ARBs was compared. Results: There were 10,223 women (8627 ACE inhibitors and 1596 ARBs) and 9475 men (8484 ACE inhibitors and 991 ARBs). Hypertension was more common in women (50.1%) than men (33.1%). Women on ARBs had better survival than those on ACE inhibitors (adjusted hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.59, 0.80). There was no difference in survival in men prescribed ARBs compared to ACE inhibitors (HR 1.10, 95% CI 0.95, 1.30). Conclusion: These sex differences in treatment-related outcome are important but should be confirmed in a randomized trial before ARBs are preferentially prescribed to women with CHF.

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Section: Introductionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Hudson

Rahme

Behlouli

et al. 2007

European J of Heart Fail

100

View full text Add to dashboard Cite

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“…[77][78][79][80] In the ELITE II study, 76 3152 elderly patients with heart failure were randomized to losartan 50 mg once daily (n ¼ 1578), or captopril 50 mg thrice daily (n ¼ 1564) and followed for 555 days. There was no difference between losartan and enalapril in all cause mortality or sudden death, although this study was designed as a superiority study for losartan.…”

Section: Heart Failurementioning

confidence: 99%

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Chrysant

Desai

2005

J Hum Hypertens

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Poorly controlled hypertension is a major risk for cardiovascular morbidity and mortality, strokes, heart failure and renal failure. Despite these devastating complications, blood pressure control of p140/90 mmHg, which is above the current standard, is very poor worldwide, accounting for 34% of hypertensive patients in the United States, and 6% in other countries. The reasons for this poor control of blood pressure include lack of aggressive treatment by physicians, especially for the systolic blood pressure, drug selection and patient compliance. The blood pressure follows a circadian rhythm and is the highest between 0600 to 1200 h, when most complications occur. Long-acting drugs that extend their action to cover this vulnerable period are preferable, especially those that block the renin-angiotensin-aldosterone system, such as ACE inhibitors and angiotensin receptor blockers, and are the most effective in controlling blood pressure and preventing or reducing its cardiovascular and renal complications. With respect to the angiotensin receptor blockers, telmisartan has been demonstrated by several studies to be the longest acting among its class of drugs and to effectively prevent the early morning rise of blood pressure.

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“…However there are also a significant number of examples in which subgroups led to additional negative studies, such as amlodipine in the elderly19 and amlodipine in patients with non‐ischemic cardiomyopathy20 or more commonly to no studies at all.…”

Section: Concluding Thoughtsmentioning

confidence: 99%

Subgroup analyses of randomized clinical trials in heart failure: facts and numbers

et al. 2016

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Subgroup analyses of major randomized clinical trials in heart failure are published frequently, but their impact on medical knowledge and practice guidelines has not been previously reported. In a novel analysis, we determined number of citations, impact factors, number of authors, and citations in guidelines of both parent trials and sub‐studies; we also qualitatively assessed whether the analyses were described as post‐hoc and non‐pre‐specified. A total of 229 sub‐studies evaluating outcomes in patient subgroups were published (median 6, range 0–36 per trial). The number of subjects in the parent trials positively correlated with number of sub‐studies (rho = 0.51, P = 0.009). The subgroups are frequently not pre‐specified. The impact factors of sub‐studies were lower in comparison to the parent trials as were the number of citations two years after the publication date; in addition, parent trials were cited more frequently in European and American professional guidelines compared with the sub‐studies. We maintain that the sub‐studies derived from major heart failure trials are frequently published, but their contribution to clinical guidelines and medical knowledge are highly debatable.

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Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II

Cited by 1,727 publications

References 32 publications

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Subgroup analyses of randomized clinical trials in heart failure: facts and numbers

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