Losartan in the Therapy of Heart Failure Patients

Abstract

The effects of losartan on myocardial remodeling and neurohumoral status were studied in 240 patients with congestive heart failure. The patients were randomized into 3 groups of 80 subjects. Each group continued to receive conventional therapy including the angiotensin-converting enzyme inhibitor enalapril. Group 1 was also given a placebo, groups 2 and 3 had losartan in doses of 25 mg and 50 mg daily, respectively. The course of treatment was 48 weeks. Cardiac function was assessed by B-mode and Doppler echocardiography. Plasma neurohormone levels were determined by radioimmunoassay. Losartan in a dose of 50 mg daily gave the best improvement in cardiac function and the most marked reduction in plasma levels of renin, angiotensin II, aldosterone, atrial natriuretic peptide, endothelin-1, and norepinephrine levels than the lower dose of losartan or placebo. The fall in cortisol and serotonin levels was similar in each group. These data demonstrate the dose-dependent effects of losartan and clarify its role in the treatment of congestive heart failure.