Effects of angiotensin-converting enzyme inhibitor plus irbesartan on maximal and submaximal exercise capacity and neurohumoral activation in patients with congestive heart failure
In patients with symptomatic congestive heart failure receiving optimal therapy with an angiotensin-converting enzyme (ACE) inhibitor and a β-blocker, the impact of using an angiotensin receptor blocker on submaximal exercise capacity and on neurohumoral activation at rest and during stress has not...
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container_title | The American heart journal |
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creator | Blanchet, Martine Sheppard, Richard Racine, Normand Ducharme, Anique Curnier, Daniel Tardif, Jean-Claude Sirois, Pierre Lamoureux, Marie-Catherine De Champlain, Jacques White, Michel |
description | In patients with symptomatic congestive heart failure receiving optimal therapy with an angiotensin-converting enzyme (ACE) inhibitor and a β-blocker, the impact of using an angiotensin receptor blocker on submaximal exercise capacity and on neurohumoral activation at rest and during stress has not been investigated.
Thirty-three patients with congestive heart failure, New York Heart Association II or III symptoms, and left ventricular ejection fraction 25.5% ± 7.2% treated with an ACE inhibitor and a β-blocker were recruited. Patients were randomly assigned to receive irbesartan 150 mg per day (n = 22) or a placebo (n = 11) for 6 months. Maximal exercise capacity was assessed using a ramp protocol. Submaximal exercise duration was assessed using a constant load protocol, and plasma norepinephrine and angiotensin II (A-II) were measured in resting state, at 6 minutes, and at peak exercise.
Patients treated with irbesartan presented a 26% increase in submaximal exercise time (+281 seconds,
P = .08) whereas exercise duration increased by only 7% in patients treated with a placebo (+128 seconds,
P = NS irbesartan vs placebo). Norepinephrine levels increased to a similar extent in both groups, whereas A-II levels did not increase or change in response to therapy.
Dual A-II suppression with an ACE inhibitor plus irbesartan provides a small but a significant increase in submaximal exercise capacity. This beneficial effect is observed despite no significant changes in maximal exercise capacity, and in resting or exercise-induced increase in neurohumoral activation. |
doi_str_mv | 10.1016/j.ahj.2004.11.011 |
format | Article |
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Thirty-three patients with congestive heart failure, New York Heart Association II or III symptoms, and left ventricular ejection fraction 25.5% ± 7.2% treated with an ACE inhibitor and a β-blocker were recruited. Patients were randomly assigned to receive irbesartan 150 mg per day (n = 22) or a placebo (n = 11) for 6 months. Maximal exercise capacity was assessed using a ramp protocol. Submaximal exercise duration was assessed using a constant load protocol, and plasma norepinephrine and angiotensin II (A-II) were measured in resting state, at 6 minutes, and at peak exercise.
Patients treated with irbesartan presented a 26% increase in submaximal exercise time (+281 seconds,
P = .08) whereas exercise duration increased by only 7% in patients treated with a placebo (+128 seconds,
P = NS irbesartan vs placebo). Norepinephrine levels increased to a similar extent in both groups, whereas A-II levels did not increase or change in response to therapy.
Dual A-II suppression with an ACE inhibitor plus irbesartan provides a small but a significant increase in submaximal exercise capacity. This beneficial effect is observed despite no significant changes in maximal exercise capacity, and in resting or exercise-induced increase in neurohumoral activation.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2004.11.011</identifier><identifier>PMID: 15894946</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>ACE inhibitors ; Adrenergic beta-Antagonists - therapeutic use ; Angiotensin II - antagonists & inhibitors ; Angiotensin II - blood ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Biological and medical sciences ; Biphenyl Compounds - therapeutic use ; Blood pressure ; Cardiology. Vascular system ; Cardiovascular disease ; Coronary vessels ; Double-Blind Method ; Drug therapy ; Drug Therapy, Combination ; Enalapril - therapeutic use ; Enzymes ; Exercise ; Exercise Tolerance - drug effects ; Female ; Heart ; Heart failure ; Heart Failure - blood ; Heart Failure - drug therapy ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Lactic Acid - blood ; Male ; Medical sciences ; Middle Aged ; Mortality ; Norepinephrine - blood ; Population ; Prospective Studies ; Rest ; Tetrazoles - therapeutic use</subject><ispartof>The American heart journal, 2005-05, Vol.149 (5), p.938.e1-938.e7</ispartof><rights>2005 Mosby, Inc.</rights><rights>2005 INIST-CNRS</rights><rights>Copyright Elsevier Limited May 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-1adc37bd8db28c417f9f19c11e6ef679693530071ef40286be84dc6a78fc87763</citedby><cites>FETCH-LOGICAL-c409t-1adc37bd8db28c417f9f19c11e6ef679693530071ef40286be84dc6a78fc87763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1504428051?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16826061$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15894946$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Blanchet, Martine</creatorcontrib><creatorcontrib>Sheppard, Richard</creatorcontrib><creatorcontrib>Racine, Normand</creatorcontrib><creatorcontrib>Ducharme, Anique</creatorcontrib><creatorcontrib>Curnier, Daniel</creatorcontrib><creatorcontrib>Tardif, Jean-Claude</creatorcontrib><creatorcontrib>Sirois, Pierre</creatorcontrib><creatorcontrib>Lamoureux, Marie-Catherine</creatorcontrib><creatorcontrib>De Champlain, Jacques</creatorcontrib><creatorcontrib>White, Michel</creatorcontrib><title>Effects of angiotensin-converting enzyme inhibitor plus irbesartan on maximal and submaximal exercise capacity and neurohumoral activation in patients with congestive heart failure</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>In patients with symptomatic congestive heart failure receiving optimal therapy with an angiotensin-converting enzyme (ACE) inhibitor and a β-blocker, the impact of using an angiotensin receptor blocker on submaximal exercise capacity and on neurohumoral activation at rest and during stress has not been investigated.
Thirty-three patients with congestive heart failure, New York Heart Association II or III symptoms, and left ventricular ejection fraction 25.5% ± 7.2% treated with an ACE inhibitor and a β-blocker were recruited. Patients were randomly assigned to receive irbesartan 150 mg per day (n = 22) or a placebo (n = 11) for 6 months. Maximal exercise capacity was assessed using a ramp protocol. Submaximal exercise duration was assessed using a constant load protocol, and plasma norepinephrine and angiotensin II (A-II) were measured in resting state, at 6 minutes, and at peak exercise.
Patients treated with irbesartan presented a 26% increase in submaximal exercise time (+281 seconds,
P = .08) whereas exercise duration increased by only 7% in patients treated with a placebo (+128 seconds,
P = NS irbesartan vs placebo). Norepinephrine levels increased to a similar extent in both groups, whereas A-II levels did not increase or change in response to therapy.
Dual A-II suppression with an ACE inhibitor plus irbesartan provides a small but a significant increase in submaximal exercise capacity. This beneficial effect is observed despite no significant changes in maximal exercise capacity, and in resting or exercise-induced increase in neurohumoral activation.</description><subject>ACE inhibitors</subject><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Angiotensin II - antagonists & inhibitors</subject><subject>Angiotensin II - blood</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Biphenyl Compounds - therapeutic use</subject><subject>Blood pressure</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Coronary vessels</subject><subject>Double-Blind Method</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Enalapril - therapeutic use</subject><subject>Enzymes</subject><subject>Exercise</subject><subject>Exercise Tolerance - drug effects</subject><subject>Female</subject><subject>Heart</subject><subject>Heart failure</subject><subject>Heart Failure - blood</subject><subject>Heart Failure - drug therapy</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>Lactic Acid - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Norepinephrine - blood</subject><subject>Population</subject><subject>Prospective Studies</subject><subject>Rest</subject><subject>Tetrazoles - therapeutic use</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9ks2O0zAUhSMEYoaBB2CDLCHYpfimju2IFRoNP9JIbGBtOc516yq1i510pjwXD8gtLRqJBSvb8nePj85xVb0EvgAO8t1mYdebRcO5WAAsOMCj6hJ4p2qphHhcXXLOm1orvryonpWyoaNstHxaXUCrO9EJeVn9uvEe3VRY8szGVUgTxhJi7VLcY55CXDGMPw9bZCGuQx-mlNlunAsLucdi82QjS5Ft7X3Y2pEkBlbm_u8R7zG7UJA5u7MuTIc_QMQ5p_W8Tfk44aawt1MgkRDZjnYYyc5dmNaMTKyw0D2yNdJbzNswzhmfV0-8HQu-OK9X1fePN9-uP9e3Xz99uf5wWzvBu6kGO7il6gc99I12ApTvPHQOACV6qTrZLdsl5wrQC07B9KjF4KRV2jutlFxeVW9PurucfszkxGxDcTiONmKai5FKN23bNQS-_gfcpDlH8mag5UI0mrdAFJwol1MpGb3ZZYopHwxwcyzUbAwVao6FGgBDhdLMq7MypYrDw8S5QQLenAFbnB19tpESf-CkbiSXR6H3Jw4psH3AbIqjqB0OIdMHMEMK_7HxG8Y1wqk</recordid><startdate>20050501</startdate><enddate>20050501</enddate><creator>Blanchet, Martine</creator><creator>Sheppard, Richard</creator><creator>Racine, Normand</creator><creator>Ducharme, Anique</creator><creator>Curnier, Daniel</creator><creator>Tardif, Jean-Claude</creator><creator>Sirois, Pierre</creator><creator>Lamoureux, Marie-Catherine</creator><creator>De Champlain, Jacques</creator><creator>White, Michel</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20050501</creationdate><title>Effects of angiotensin-converting enzyme inhibitor plus irbesartan on maximal and submaximal exercise capacity and neurohumoral activation in patients with congestive heart failure</title><author>Blanchet, Martine ; Sheppard, Richard ; Racine, Normand ; Ducharme, Anique ; Curnier, Daniel ; Tardif, Jean-Claude ; Sirois, Pierre ; Lamoureux, Marie-Catherine ; De Champlain, Jacques ; White, Michel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-1adc37bd8db28c417f9f19c11e6ef679693530071ef40286be84dc6a78fc87763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>ACE inhibitors</topic><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Angiotensin II - antagonists & inhibitors</topic><topic>Angiotensin II - blood</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Biphenyl Compounds - therapeutic use</topic><topic>Blood pressure</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Coronary vessels</topic><topic>Double-Blind Method</topic><topic>Drug therapy</topic><topic>Drug Therapy, Combination</topic><topic>Enalapril - therapeutic use</topic><topic>Enzymes</topic><topic>Exercise</topic><topic>Exercise Tolerance - drug effects</topic><topic>Female</topic><topic>Heart</topic><topic>Heart failure</topic><topic>Heart Failure - blood</topic><topic>Heart Failure - drug therapy</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>Lactic Acid - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Norepinephrine - blood</topic><topic>Population</topic><topic>Prospective Studies</topic><topic>Rest</topic><topic>Tetrazoles - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Blanchet, Martine</creatorcontrib><creatorcontrib>Sheppard, Richard</creatorcontrib><creatorcontrib>Racine, Normand</creatorcontrib><creatorcontrib>Ducharme, Anique</creatorcontrib><creatorcontrib>Curnier, Daniel</creatorcontrib><creatorcontrib>Tardif, Jean-Claude</creatorcontrib><creatorcontrib>Sirois, Pierre</creatorcontrib><creatorcontrib>Lamoureux, Marie-Catherine</creatorcontrib><creatorcontrib>De Champlain, Jacques</creatorcontrib><creatorcontrib>White, Michel</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Blanchet, Martine</au><au>Sheppard, Richard</au><au>Racine, Normand</au><au>Ducharme, Anique</au><au>Curnier, Daniel</au><au>Tardif, Jean-Claude</au><au>Sirois, Pierre</au><au>Lamoureux, Marie-Catherine</au><au>De Champlain, Jacques</au><au>White, Michel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of angiotensin-converting enzyme inhibitor plus irbesartan on maximal and submaximal exercise capacity and neurohumoral activation in patients with congestive heart failure</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2005-05-01</date><risdate>2005</risdate><volume>149</volume><issue>5</issue><spage>938.e1</spage><epage>938.e7</epage><pages>938.e1-938.e7</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>In patients with symptomatic congestive heart failure receiving optimal therapy with an angiotensin-converting enzyme (ACE) inhibitor and a β-blocker, the impact of using an angiotensin receptor blocker on submaximal exercise capacity and on neurohumoral activation at rest and during stress has not been investigated.
Thirty-three patients with congestive heart failure, New York Heart Association II or III symptoms, and left ventricular ejection fraction 25.5% ± 7.2% treated with an ACE inhibitor and a β-blocker were recruited. Patients were randomly assigned to receive irbesartan 150 mg per day (n = 22) or a placebo (n = 11) for 6 months. Maximal exercise capacity was assessed using a ramp protocol. Submaximal exercise duration was assessed using a constant load protocol, and plasma norepinephrine and angiotensin II (A-II) were measured in resting state, at 6 minutes, and at peak exercise.
Patients treated with irbesartan presented a 26% increase in submaximal exercise time (+281 seconds,
P = .08) whereas exercise duration increased by only 7% in patients treated with a placebo (+128 seconds,
P = NS irbesartan vs placebo). Norepinephrine levels increased to a similar extent in both groups, whereas A-II levels did not increase or change in response to therapy.
Dual A-II suppression with an ACE inhibitor plus irbesartan provides a small but a significant increase in submaximal exercise capacity. This beneficial effect is observed despite no significant changes in maximal exercise capacity, and in resting or exercise-induced increase in neurohumoral activation.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>15894946</pmid><doi>10.1016/j.ahj.2004.11.011</doi></addata></record> |
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subjects | ACE inhibitors Adrenergic beta-Antagonists - therapeutic use Angiotensin II - antagonists & inhibitors Angiotensin II - blood Angiotensin-Converting Enzyme Inhibitors - therapeutic use Biological and medical sciences Biphenyl Compounds - therapeutic use Blood pressure Cardiology. Vascular system Cardiovascular disease Coronary vessels Double-Blind Method Drug therapy Drug Therapy, Combination Enalapril - therapeutic use Enzymes Exercise Exercise Tolerance - drug effects Female Heart Heart failure Heart Failure - blood Heart Failure - drug therapy Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Lactic Acid - blood Male Medical sciences Middle Aged Mortality Norepinephrine - blood Population Prospective Studies Rest Tetrazoles - therapeutic use |
title | Effects of angiotensin-converting enzyme inhibitor plus irbesartan on maximal and submaximal exercise capacity and neurohumoral activation in patients with congestive heart failure |
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