Volume 1, Number 2, June 2000

Ongoing Clinical trials with angiotensin II receptor antagonists in chronic heart failure and myocardial infarction
John McMurray, Colin Berry

A number of large scale landmark trials have shown that angiotensin-converting enzyme inhibitors (ACE-I) reduce mortality and morbidity in patients with chronic heart failure (CHF). Recently it has been shown that the use of high doses of ACE-I are more effective in this respect than low doses and moreover, that blocking the renin-angiotensin-aldosterone system (RAAS) with an aldosterone antagonist in addition to an ACE-I is also more effective than ACE inhibition alone. With the introduction of angiotensin receptor blockers (ARBs) into clinical practice, the question arises as to whether these will have a role in the management of CHF and acute myocardial infarction (AMI).
These drugs are likely to confer greater benefit than placebo and, in theory, may even prove to be superior to ACE-I because of more complete blockade of the actions of angiotensin II (Ang II) . Alternatively, they may prove to be similar in terms of efficacy, but with the benefit of improved tolerability. It is also possible that a combination of an ACE-I and an ARB will be more clinically effective than monotherapy with either agent alone.
This review examines the available data on comparisons of ARBs and placebo, ARBs and ACE-I, and the combination of ACE-I and ARBs vs. monotherapy, in the treatment of patients with CHF and AMI. The progress and design of ongoing trials with ARBs in CHF and AMI are also discussed.

JRAAS 2000;1:131-136.

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