阿利吉仑在背景剂量 ACE 抑制剂的心力衰竭患者中的效果：ALOFT 试验的回顾性分析。

Effect of aliskiren in patients with heart failure according to background dose of ACE inhibitor: a retrospective analysis of the Aliskiren Observation of Heart Failure Treatment (ALOFT) trial.

机构信息

British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.

出版信息

Cardiovasc Drugs Ther. 2011 Aug;25(4):315-21. doi: 10.1007/s10557-011-6319-3.

DOI:10.1007/s10557-011-6319-3

PMID:21779784

Abstract

AIMS

To compare the effect of the direct renin inhibitor aliskiren on neurohumoral activity in heart failure patients treated with low-dose and high-dose ACE inhibitor.

METHODS

A retrospective analysis of the ALOFT trial. Comparison of the effects of 6 months treatment with aliskiren (versus placebo) in patients receiving <guideline-recommended dose of ACE inhibitor (n = 109) with those receiving ≥ recommended-dose (n = 81). Neurohumoral measures included B-type natriuretic peptide (BNP), NT proBNP, plasma renin activity and urinary aldosterone excretion.

RESULTS

Patients in each ACE inhibitor-dose group were generally similar (those in the ≥ recommended ACE inhibitor-dose had higher baseline blood-pressures and LVEF and were more often female and diabetic). In the <recommended-dose sub-group, the reduction in BNP from baseline to end-of-study was -1% (95% CI -32 to +44%) in the placebo-group and -32% (-1 to -53%) in the aliskiren group. The corresponding reductions in the ≥recommended ACE inhibitor-dose sub-group were: placebo -19% (-46 to +22%) and aliskiren -46% (-22 to -62%); interaction p-value 0.94. The pattern of results for other neurohumoral markers was similar.

CONCLUSIONS

Aliskiren causes neurohumoral suppression in heart failure, even in patients treated with ≥recommended-dose of ACE inhibitor.

摘要

目的

比较直接肾素抑制剂阿利吉仑对接受低剂量和高剂量 ACE 抑制剂治疗的心衰患者神经激素活性的影响。

方法

对 ALOFT 试验进行回顾性分析。比较 6 个月阿利吉仑（与安慰剂相比）治疗接受<指南推荐剂量 ACE 抑制剂（n=109）患者与接受≥推荐剂量 ACE 抑制剂（n=81）患者的效果。神经激素测量包括 B 型利钠肽（BNP）、NT proBNP、血浆肾素活性和尿醛固酮排泄。

结果

每个 ACE 抑制剂剂量组的患者通常相似（接受≥推荐剂量 ACE 抑制剂的患者基线血压和左心室射血分数更高，且更常为女性和糖尿病患者）。在<推荐剂量亚组中，安慰剂组从基线到研究结束时 BNP 降低 1%（95%CI -32 至 +44%），阿利吉仑组降低 32%（-1 至 -53%）。相应地，在≥推荐剂量 ACE 抑制剂亚组中，安慰剂组降低 19%（-46 至 +22%），阿利吉仑组降低 46%（-22 至 -62%）；交互 p 值为 0.94。其他神经激素标志物的结果模式相似。