Therapeutic Research

Abstract

We examined the effects of combination therapy of an ACE inhibitor and angiotensin I I receptor blocker on hemodynamics and left ventricular mass（LVM）in patients with chronic heart failure. A tissue−selective ACE inhibitor（quinapril or trandolapril）or valsartan was administered to 26 patients demonstrating New York Heart Association（NYHA）classification I I moderate to I I I for 3 months in a single−blind manner. Valsartan was concomitantly administered to the primary ACE inhibitor group（n＝14）and to the primary valsartan group （n＝12）, ACE inhibitor was concomitantly administered for another 3 months. We performed echocardiography and measured endocrine hormones to compare the results. Left ventricular end−diastolic diameter（LVDd）significantly decreased from 59±8 to 53± 12 mm in the ACE inhibitor group and from 58±6 to 51±7 mm in the valsartan group while ejection fraction（EF）significantly increased from 30±7 to 48±13％ in the ACE inhibitor group and from 32±5 to 53±11％ in the valsartan group. Administration of valsartan on an ACE inhibitor significantly improved LVDd and EF by 11％ and 25％, respectively, whereas additive administration of an ACE inhibitor to valsartan showed no further improvement. Similar results were obtained for left ventricular mass index（LVMI）. Additional administration of valsartan to a tissue−selective ACE inhibitor could further improve cardiac function and reduce LVM, whereas additional administration of a tissue−selective ACE inhibitor to valsartan exhibited no similar effect.