The Journal of Informed Pharmacotherapy 2004;15:151.
Reviewer: James McCormack, B.Sc. (Pharm), Pharm. D.
Reviewer's email address: email@example.com
Reviewer's profession/specialty: Associate Editor, Journal of Informed Pharmacotherapy
Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Kober L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM; Valsartan in Acute Myocardial Infarction Trial Investigators. N Engl J Med 2003;349:1893-906 PubMed Citation
These investigators compared valsartan, captopril or both in patients with heart failure following an acute myocardial infarction.
14,703 patients with an acute myocardial infarction complicated by heart failure (Class 1 - 28%, Class 2 - 48%, Class 3 - 18%, Class 4 - 6%). The average age of the patients was 65 years and 31% were female.
Patients were randomized in a blinded fashion to receive either valsartan (20mg PO daily increased to 160 mg PO BID), captopril (6.25mg PO daily increased up to 50 mg PO TID) or both valsartan (20mg PO daily increased to 80 mg PO BID) and captopril (6.25mg PO daily increased up to 50 mg PO TID).
The median study duration was 25 months.
There was no difference between groups in any end point. End points included death from cardiovascular causes, myocardial infarction, heart failure, resuscitation after cardiac arrest and stroke.
Overall adverse events were 5-6% higher in the combination group.
This study suggests that valsartan and captopril are equally effective in the treatment of an acute myocardial infarction complicated with heart failure and the combination of these agents is no more effective than the single agents alone.
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