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Article: The Hong Kong diastolic heart failure study: A randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction

TitleThe Hong Kong diastolic heart failure study: A randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction
Authors
Issue Date2008
PublisherB M J Publishing Group. The Journal's web site is located at http://heart.bmjjournals.com/
Citation
Heart, 2008, v. 94 n. 5, p. 573-580 How to Cite?
AbstractBackground: Although heart failure with a preserved or normal ejection fraction (HFNEF or diastolic heart failure) is common, treatment outcomes on quality of life and cardiac function are lacking. The effect of renin-angiotensin blockade by irbesartan or ramipril in combination with diuretics on quality of life (QoL), regional and global systolic and diastolic function was assessed in HFNEF patients. Methods: 150 patients with HFNEF (LVEF >45%) were randomised to (1) diuretics alone, (2) diuretics plus irbesartan, or (3) diuretics plus ramipril. QoL, 6-minute walk test (6MWT) and Doppler echocardiography were performed at baseline, 12, 24 and 52 weeks. Results: The QoL score improved similarly in all three groups by 52 weeks (-46%, 51%, and 50% respectively, all p<0.01), although 6MWT increased only slightly (average +3-6%). Recurrent hospitalisation rates were equal in all groups (10-12% in 1 year). At 1 year, LV dimensions or LVEF had not changed in any group, though both systolic and diastolic blood pressures were lowered in all three groups from 4 weeks onwards. At baseline both mean peak systolic (Sm) and early diastolic (Em) mitral annulus velocities were reduced, and increased slightly in the diuretic plus irbesartan (Sm 4.5 (SEM 0.17) to 4.9 (SEM 0.16) cm/sec; Em 3.8 (SEM 0.25) to 4.2 (SEM 0.25) cm/sec) and ramipril (Sm 4.5 (SEM 0.24) to 4.9 (SEM 0.20) cm/sec; Em 3.3 (SEM 0.25) to 4.04 (SEM 0.32) cm/sec) groups (both p<0.05). NT-pro-BNP levels were raised at baseline (595 (SD 905) pg/ml; range 5-4748) and fell in the irbesartan (-124 (SD 302) pg/ml, p = 0.01) and ramipril (-173 (SD 415) pg/ml, p = 0.03) groups only. Conclusions: In this typically elderly group of HF patients with normal LVEF, diuretic therapy significantly improved symptoms and neither irbesartan nor ramipril had a significant additional effect. However, diuretics in combination with irbesartan or ramipril marginally improved LV systolic and diastolic longitudinal LV function, and lowered NT-proBNP over 1 year.
Persistent Identifierhttp://hdl.handle.net/10722/76679
ISSN
2015 Impact Factor: 5.693
2015 SCImago Journal Rankings: 2.647
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorYip, GWKen_HK
dc.contributor.authorWang, Men_HK
dc.contributor.authorWang, Ten_HK
dc.contributor.authorChan, Sen_HK
dc.contributor.authorFung, JWHen_HK
dc.contributor.authorYeung, Len_HK
dc.contributor.authorYip, Ten_HK
dc.contributor.authorLau, STen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorTang, MOen_HK
dc.contributor.authorYu, CMen_HK
dc.contributor.authorSanderson, Jen_HK
dc.date.accessioned2010-09-06T07:23:47Z-
dc.date.available2010-09-06T07:23:47Z-
dc.date.issued2008en_HK
dc.identifier.citationHeart, 2008, v. 94 n. 5, p. 573-580en_HK
dc.identifier.issn1355-6037en_HK
dc.identifier.urihttp://hdl.handle.net/10722/76679-
dc.description.abstractBackground: Although heart failure with a preserved or normal ejection fraction (HFNEF or diastolic heart failure) is common, treatment outcomes on quality of life and cardiac function are lacking. The effect of renin-angiotensin blockade by irbesartan or ramipril in combination with diuretics on quality of life (QoL), regional and global systolic and diastolic function was assessed in HFNEF patients. Methods: 150 patients with HFNEF (LVEF >45%) were randomised to (1) diuretics alone, (2) diuretics plus irbesartan, or (3) diuretics plus ramipril. QoL, 6-minute walk test (6MWT) and Doppler echocardiography were performed at baseline, 12, 24 and 52 weeks. Results: The QoL score improved similarly in all three groups by 52 weeks (-46%, 51%, and 50% respectively, all p<0.01), although 6MWT increased only slightly (average +3-6%). Recurrent hospitalisation rates were equal in all groups (10-12% in 1 year). At 1 year, LV dimensions or LVEF had not changed in any group, though both systolic and diastolic blood pressures were lowered in all three groups from 4 weeks onwards. At baseline both mean peak systolic (Sm) and early diastolic (Em) mitral annulus velocities were reduced, and increased slightly in the diuretic plus irbesartan (Sm 4.5 (SEM 0.17) to 4.9 (SEM 0.16) cm/sec; Em 3.8 (SEM 0.25) to 4.2 (SEM 0.25) cm/sec) and ramipril (Sm 4.5 (SEM 0.24) to 4.9 (SEM 0.20) cm/sec; Em 3.3 (SEM 0.25) to 4.04 (SEM 0.32) cm/sec) groups (both p<0.05). NT-pro-BNP levels were raised at baseline (595 (SD 905) pg/ml; range 5-4748) and fell in the irbesartan (-124 (SD 302) pg/ml, p = 0.01) and ramipril (-173 (SD 415) pg/ml, p = 0.03) groups only. Conclusions: In this typically elderly group of HF patients with normal LVEF, diuretic therapy significantly improved symptoms and neither irbesartan nor ramipril had a significant additional effect. However, diuretics in combination with irbesartan or ramipril marginally improved LV systolic and diastolic longitudinal LV function, and lowered NT-proBNP over 1 year.en_HK
dc.languageengen_HK
dc.publisherB M J Publishing Group. The Journal's web site is located at http://heart.bmjjournals.com/en_HK
dc.relation.ispartofHearten_HK
dc.rightsHeart. Copyright © B M J Publishing Group.en_HK
dc.subject.meshAgeden_HK
dc.subject.meshAntihypertensive Agents - therapeutic useen_HK
dc.subject.meshBiphenyl Compounds - therapeutic useen_HK
dc.subject.meshDiuretics - therapeutic useen_HK
dc.subject.meshDrug Therapy, Combinationen_HK
dc.subject.meshEchocardiography - methodsen_HK
dc.subject.meshEpidemiologic Methodsen_HK
dc.subject.meshExercise Toleranceen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHeart Failure, Diastolic - drug therapy - psychologyen_HK
dc.subject.meshHong Kongen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshQuality of Life - psychologyen_HK
dc.subject.meshRamipril - therapeutic useen_HK
dc.subject.meshTetrazoles - therapeutic useen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.subject.meshVentricular Dysfunction, Left - drug therapy - psychologyen_HK
dc.titleThe Hong Kong diastolic heart failure study: A randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fractionen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1355-6037&volume=94&issue=5&spage=573&epage=580&date=2008&atitle=The+Hong+Kong+diastolic+heart+failure+study:+a+randomised+controlled+trial+of+diuretics,+irbesartan+and+ramipril+on+quality+of+life,+exercise+capacity,+left+ventricular+global+and+regional+function+in+heart+failure+with+a+normal+ejection+fraction.en_HK
dc.identifier.emailWang, M:meiwang@hkucc.hku.hken_HK
dc.identifier.authorityWang, M=rp00281en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1136/hrt.2007.117978en_HK
dc.identifier.pmid18208835-
dc.identifier.scopuseid_2-s2.0-42549149364en_HK
dc.identifier.hkuros155820en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-42549149364&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume94en_HK
dc.identifier.issue5en_HK
dc.identifier.spage573en_HK
dc.identifier.epage580en_HK
dc.identifier.isiWOS:000254969300014-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridYip, GWK=7006525328en_HK
dc.identifier.scopusauthoridWang, M=7406690398en_HK
dc.identifier.scopusauthoridWang, T=51565230500en_HK
dc.identifier.scopusauthoridChan, S=13309484300en_HK
dc.identifier.scopusauthoridFung, JWH=7203073343en_HK
dc.identifier.scopusauthoridYeung, L=7004462802en_HK
dc.identifier.scopusauthoridYip, T=8973604300en_HK
dc.identifier.scopusauthoridLau, ST=8649658200en_HK
dc.identifier.scopusauthoridLau, CP=7401968501en_HK
dc.identifier.scopusauthoridTang, MO=36832155900en_HK
dc.identifier.scopusauthoridYu, CM=7404976646en_HK
dc.identifier.scopusauthoridSanderson, J=7202371250en_HK
dc.identifier.citeulike3870525-

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