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Angiotensin II has been implicated in the onset and progression of chronic systolic heart failure. ACE inhibition, which blocks production of angiotensin II, markedly improves morbidity and mortality in patients with systolic heart failure and is considered first-line therapy. Can adding angiotensin-receptor blockers (ARBs) to therapy enhance these benefits?
In the manufacturer-supported, double-blind Valsartan Heart Failure Trial, 5010 patients with symptomatic heart failure and left-ventricular ejection fractions <40% were randomized to receive the ARB valsartan (target dose, 160 mg) or placebo twice daily. Nearly 93% of patients were taking ACE inhibitors.
During follow-up (mean, 23 months), no between-groups differences were found in all-…