Combination therapy with angiotensin-receptor blocker valsacor and aldosterone blocker spironolactone in heart failure

Angiotensin-converting enzyme (ACE) inhibitors are recommended as the first-line drugs for the prevention of cardiovascular diseases. There is evidence that new class of angiotensin receptor blockers (ARBs) have at least the same efficacy for the prevention of cardiovascular disease as ACE inhibitors in patients with heart failure due to the attenuation of excessive renin-angiotensin system activity. Data on efficacy of aldosterone synthesis blockage for the prevention of chronic heart failure have been accumulated in large randomized clinical trials. The aim of the study was to investigate efficacy of combination blockage of angiotensin II receptor, type 1 (AT 1 receptors) and aldosterone receptors for correction of arterial stiffness and neurohormonal abnormalities in chronic heart failure. We analyzed long-term (6-month) efficacy and safety of combination therapy with ARB (valsakor) and aldosterone receptor blocker (spironolactone) in 34 patients (age 62.3±3.9 years) mainly with NYHA class III heart failure and reduced ejection fraction (EF) - 33%. Quantification of left ventricular stiffness and ventricular-arterial coupling was performed by using three-dimensional echocardiography. We tested blood NT-proBNP level by BNP-assay and serum aldosterone by the direct radioimmunoassay. During 6 months of the study, all patients received pathogenetic therapy. Data showed favorable clinical dynamics in general condition of patients, regression of left ventricular remodeling, improvement in indexes of arterial stiffness and cardiac inotropic function resulting in reliable increase in EF (р=0.003). Serum levels of neuromediators, NT-proBNP and aldosterone, showed clear tendency to decrease compared with the initial values. Therefore, the long-term pathogenetic combination therapy of NYHA class III heart failure with valsakor and spironolactone is safe and efficacious. It results in the regression of heart failure, moderate reversal of left ventricular remodeling and increased arterial stiffness, and improvement of the prognosis for the disease.