Konstam Marvin A, Neaton James D, Poole-Wilson Philip A, Pitt Bertram, Segal Robert, Sharma Divakar, Dasbach Erik J, Carides George W, Dickstein Kenneth, Riegger Günter, Camm A John, Martinez Felipe A, Bradstreet Deborah C, Ikeda Leila S, Santoro Emanuela P
Division of Cardiology, Tufts-New England Medical Center, Boston, MA 02111, USA.
Am Heart J. 2005 Jul;150(1):123-31. doi: 10.1016/j.ahj.2004.10.035.
Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors improves outcomes and symptoms in patients with heart failure (HF). We compared effects of losartan to captopril on mortality, morbidity, and functional status for patients in the ELITE II study.
A total of 3152 patients, aged 60 years or older, with New York Heart Association (NYHA) classes II to IV HF and ejection fraction < or = 40% were assigned to receive losartan 50 mg once daily or captopril 50 mg 3 times daily. Outcome measures included all-cause and HF-related mortality, hospitalizations, and discontinuations; change in NYHA class; and quality of life (QoL). HF-related outcomes were not significantly different between therapies. Similar improvements from baseline (P < .01) in NYHA class were observed within both treatment groups. Among 1856 QoL participants, 1343 patients survived at least 1 year; the QoL for 1-year survivors improved in both treatment groups (P < .001 vs baseline) and did not differ between groups.
In ELITE II, the effects of losartan on HF-related outcomes, NYHA class, and QoL were not superior to those of captopril. Although angiotensin-converting enzyme inhibitors remain the treatment of choice for patients with HF, the similarity of the findings in the present analysis supports a role for angiotensin-receptor antagonists in this patient population.
使用血管紧张素转换酶抑制剂阻断肾素-血管紧张素系统可改善心力衰竭（HF）患者的预后和症状。在ELITE II研究中，我们比较了氯沙坦与卡托普利对患者死亡率、发病率和功能状态的影响。
共有3152例年龄在60岁及以上、纽约心脏协会（NYHA）心功能II至IV级且射血分数≤40%的HF患者，被分配接受每日一次50mg氯沙坦或每日三次50mg卡托普利治疗。观察指标包括全因死亡率、与HF相关的死亡率、住院率、停药率；NYHA心功能分级的变化；以及生活质量（QoL）。两种治疗方法在与HF相关的预后方面无显著差异。两个治疗组内均观察到NYHA心功能分级较基线有相似的改善（P<.01）。在1856例参与QoL评估的患者中，1343例患者存活至少1年；两个治疗组中1年存活者的QoL均有所改善（与基线相比P<.001），且两组间无差异。
在ELITE II研究中，氯沙坦在与HF相关的预后、NYHA心功能分级和QoL方面的效果并不优于卡托普利。虽然血管紧张素转换酶抑制剂仍然是HF患者的首选治疗药物，但本分析结果的相似性支持血管紧张素受体拮抗剂在该患者群体中的作用。
