Comparison of losartan and captopril on heart failure–related outcomes and symptoms from the losartan heart failure survival study (ELITE II)

• Published in: The American heart journal 2005-07, Vol.150 (1), p.123-131
• Main Authors: 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.
• Format: Article
• Language: English
• Subjects: ACE inhibitors; Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Captopril - therapeutic use; Cardiology. Vascular system; Drug dosages; Drug therapy; Female; Heart; Heart failure; Heart Failure - complications; Heart Failure - drug therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospitalization; Humans; Losartan - therapeutic use; Male; Medical sciences; Morbidity; Mortality; Patients; Survival
• ISSN: 0002-8703; 1097-6744
• 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 ≤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.