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INHERIT: Losartan did not improve left ventricular mass in patients with hypertrophic cardiomyopathy
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CHICAGO — Use of losartan in patients with overt hypertrophic cardiomyopathy had no effect on left ventricular mass or endpoints such as maximal wall thickness, left ventricular fibrosis, diastolic parameters and exercise capacity when compared with placebo.
Currently, no medical treatment has been reliably demonstrated to alter the disease progression or outcomes of patients with hypertrophic cardiomyopathy, Anna Axelsson, MD, from the department of cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark, said during a presentation. As a result, Axelsson and colleagues conducted the randomized, double blind, single-center, placebo-controlled INHERIT study to test whether the angiotensin receptor blocker losartan benefits LV morphology and function in patients with hypertrophic cardiomyopathy.
In total, 133 patients were randomly assigned losartan (n=64; mean age, 52 years; 67% men) or placebo (n=69; mean age, 51 years; 62% men) and followed for an average of 372 days. Patients were well balanced, with no significant differences in characteristics at baseline, Axelsson said.
At study completion, 93% of remaining patients were compliant, which the researchers determined by pill count.
The primary endpoint of change in LV mass determined by MRI or CT was comparable between the treatment groups (P=.6). Likewise, there were no significant differences in the following secondary endpoints: maximal wall thickness (P=.26); LV fibrosis (P=.62); left atrial volume (P=.69); NT-proBNP levels (P=.67); and estimated peak V02 capacity (P=.08).
In addition, adverse events were few and comparable between groups, Axelsson said.
“The observed safety suggests that losartan may be used for other indications in patients with hypertrophic cardiomyopathy regardless of obstruction of blood outflow,” Axelsson said. “Future studies may determine if treatment with angiotensin receptor blockers can prevent the development of disease in preclinical and early stages of hypertrophic cardiomyopathy.” – by Brian Ellis
For more information:
Axelsson A. LBCT.03: Treatment of Structural Heart Disease. Presented at: American Heart Association Scientific Sessions; Nov. 15-19, 2014; Chicago.
Disclosure: Axelsson reports previously owning stock in AstraZeneca.
Perspective
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Mark A. Creager, MD, FAHA, FACC
Well-done clinical trials are always important, regardless of whether they are positive or negative, because they add to our knowledge base. In this trial, there was a very sound rationale to conduct a trial looking at an angiotensin receptor blocker in patients with hypertrophic cardiomyopathy in whom there is no evidence-based therapy to guide our management to favorably affect their outcomes. In other populations where there is LV hypertrophy, including patients with hypertension, angiotensin receptor blockers have been shown to favorably affect LV wall mass. Unfortunately for the medical community and the public, the results of this trial were negative, meaning we do not have a new therapy to offer patients with hypertrophic cardiomyopathy. But we now have additional knowledge and we will use that knowledge and move forward.
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