Losartan in Decompensated Heart Failure
Losartan in Decompensated Heart Failure
The dual blockade of the renin-angiotensin-aldosterone system with an angiotensin-converting
 enzyme inhibitor and an angiotensin-receptor blocker used together in heart failure patients
 has been demonstrated to be beneficial. However, the dual inhibition has not been studied
 during heart failure decompensation or even when low cardiac output is present.

 The objective of this study was to assess the effects of add-on therapy with angiotensin
 receptor blocker on plasma B-type natriuretic peptide levels and hemodynamic measurements in
 heart failure patients with low cardiac output during hospitalization for decompensation.

 This was a randomized, double-blind, placebo-controlled clinical trial.
The inclusion criteria were hospitalization for decompensated heart failure defined by
 worsening of symptoms until fatigue or dyspnea at rest, low cardiac output defined by the
 clinical-hemodynamic profile, dobutamine dependence, and ejection fraction < 0.45,
 spontaneous breathing and receiving angiotensin-converting enzyme inhibitors. The patients
 could have jugular ingurgitation, lower limbs edema, ascites and rales. Dobutamine dependence
 was defined by infusion for more than 15 days or an unsuccessful attempt of withdrawal.

 The exclusion criteria were serum creatinine > 3.0 mg/dL, serum potassium > 6.0 mEq/L,
 systolic blood pressure < 70 mm Hg, aortic stenosis, and acute coronary syndrome in the
 previous 2 months. The patients were randomly assigned by permuted block of 4, stratified by
 sex, to losartan or placebo.

 The endpoints were change in B-type natriuretic peptide levels, cardiac index, pulmonary
 wedge capillary pressure, systemic vascular resistance, and successful withdrawal of
 dobutamine.
Inclusion Criteria:

 -  hospitalization for decompensated heart failure

 -  dobutamine dependence

 -  ejection fraction < 0.45

 -  taking angiotensin-converting enzyme inhibitor

 Exclusion Criteria:

 -  serum creatinine > 3.0 mg/dL

 -  serum potassium > 6.0 mEq/L

 -  systolic blood pressure < 70 mm Hg

 -  aortic stenosis

 -  acute coronary syndrome in the previous 2 months