Effect of the Angiotensin Receptor Blocker Valsartan on Morbidity and Mortality in Heart Failure: the Valsartan Heart Failure Trial (Val-HeFT)
In order to assess the efficacy of the angiotensin receptor blocker valsartan in the treatment of heart failure (HF), 5010 patients were studied in 16 countries on 4 continents. Patients with chronic HF [NYHA II (62%), III (36%) and IV (2%)], ejection fraction (EF) <40% and left ventricular diastolic transverse diameter (LVIDD) >2.9 cm/m2 were randomly assigned to receive placebo (P) or valsartan (V) (titrated to 160 mg BID) in addition to all other appropriate therapy including ACE inhibitors (93%), beta blockers (36%), diuretics (86%) and digoxin (67%). Primary end-points were all-cause mortality (M) and mortality plus morbidity (M+M), which included hospitalization for heart failure (adjudicated), cardiac arrest with resuscitation, or need for intravenous support for worsening heart failure. Time to death was similar in the two groups but time to first M+M event was significantly reduced by 13.3% by V (32.1% in P, 28.8% in V; P=0.009). HF hospitalization was significantly reduced by 27.5% by V (18.5% in P, 13.9% in V; (P<0.001). The benefit of V on M+M was particularly prominent in patients not taking a beta blocker (37.0% to 30.8%, P<0.001) and in those not taking an ACE inhibitor (42.5% to 24.9%, P<0.001). The benefit on M+M was accompanied by significant improvements in NYHA class, quality of life, and EF. These data demonstrate clinical efficacy of valsartan in heart failure in patients already receiving standard HF therapy.
- Copyright © 2000 by American Heart Association