Background: Mainly because of cough, many asian peoples were not received ACE inhibitors (ACEI). Based on Val-HeFT results, valsartan appears to be an effective therapy in ACEI-intolerant patients. We evaluated the effects of valsartan on surrogate clinical markers in the patients with chronic heart failure (HF) not receiving ACEI in Korea.
Method: This trial was a prospective, multi-institutional, single arm, open labeled trial. Patients with stable, symptomatic HF who were on prescribed HF therapy, with feasible Val-HeFT criteria (EF < 40% and LV internal diameter in diastole >2.9 cm/m²) were enrolled from Feb.2005 to May 2007 at 6 university hospitals. Valsartan adjustment schedule were performed forced titration method equal to Val-HeFT. Clinical profiles, echocardiography and BNP (Bayer) were checked before enrollment and 6 month later. We evaluated and compared the change of several clinical data from baseline to last visit. Results: To data, 83 patients have been enrolled and 58 patients have successfully completed. Baseline characteristics are as follows: mean age 59.5±10.1, mean systolic BP 114.0±18.4mmHg, 59.4 % male, 73/20% NYHA II/III, 17.2% hypertension. The mean dose of valsartan was 174mg/day, approaching optimal dose (≥160mg) was achieved in 68.8 % and approaching target dose (320mg) was 25%. 52.1 % of beta blocker, 52.1% of digoxin were received. After valsartan treatment, symptom and sign, NYHA class was significantly improved (2.29±0.5 to 1.94±0.4). EF significantly increased (29.0±7.5 to 34.2±11.5 %), LV diameter significantly reduced (3.97±0.7 to 3.83±0.8 cm/m²) and BNP levels significantly reduced (226.4±437.6 to 132.4±226.5 pg/ml) (p<0.05). There were no significant differences in clinical profiles between optimal and suboptimal use of valsartan. Systolic BP was reduced by mean 4.4±16.9 mmHg after treatment. 29.1% of patients were complained symptom of dizziness or hypotension but drug discontinuation and renal impairment was not noted. Conclusion: In Korean patients with chronic stable HF not receiving ACEI, despite of relatively low dose, using a valsartan treatment were significantly improved clinical surrogate markers of HF.
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