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Clinical impacts of additive use of olmesartan in hypertensive patients with chronic heart failure: the supplemental benefit of an angiotensin receptor blocker in hypertensive patients with stable heart failure using olmesartan (SUPPORT) trial

2015; Oxford University Press; Volume: 36; Issue: 15 Linguagem: Inglês

10.1093/eurheartj/ehu504

1522-9645

Yasuhiko Sakata, Nobuyuki Shiba, Jun Takahashi, Satoshi Miyata, Kotaro Nochioka, Masanobu Miura, Tsuyoshi Takada, Chiharu Saga, Tsuyoshi Shinozaki, Masafumi Sugi, Makoto Nakagawa, Nobuyo Sekiguchi, Tatsuya Komaru, Atsushi Kato, Mitsumasa Fukuchi, Eiji Nozaki, Tetsuya Hiramoto, Kanichi Inoue, Toshikazu Goto, Masatoshi Ohe, Kenji Tamaki, Setsuro Ibayashi, Nobumasa Ishide, Yukio Maruyama, Ichiro Tsuji, Hiroaki Shimokawa, Hiroaki Shimokawa, Mitsumasa Fukuchi, Toshikazu Goto, Tetsuya Hiramoto, Koetsu Inoue, Akira Kato, Tatsuya Komaru, Masatoshi Ohe, Nobuo Sekiguchi, Nobuyuki Shiba, Tsuyoshi Shinozaki, M. Sugi, Kenji Tamaki, Tetsuya Hiramoto, Koetsu Inoue, Akira Kato, Masaki Ogata, Shinya Sato, M. Sugi, Nobumasa Ishide, Setsuro Ibayashi, Yukio Maruyama, I Ohno, Kenji Tamaki, Hiroshi Ogawa, Masafumi Kitakaze, Ichiro Tsuji, Tomoyuki Watanabe, Kemmyo Sugiyama, Shin‐ichiro Oyama, Eiji Nozaki, Asako Nakamura, Takashi Takahashi, Hiroshi Endô, S. Fukui, S Nakajima, Makoto Nakagawa, Tomoyoshi Nozaki, Takeshi Yagi, S. Horiguchi, E. Fushimi, Yukio Sugai, Seiji Takeda, Kohei Fukahori, Koki Aizawa, Masatoshi Ohe, Tetsuzo Tashima, Katsuhiko Sakurai, Toshihiro Kobayashi, Toshikazu Goto, Motoyuki Matsui, Yosuke Tamada, Tomoyasu Yahagi, Akio Fukui, Kousuke Takahashi, Kousuke Takahashi, Yoku Kikuchi, K. Akai, Hiroshi Kanno, Juntaro Kaneko, S. Suzuki, Kousuke Takahashi, K. Akai, Dai Katayose, Shin‐ichi Onodera, Tetsuya Hiramoto, S. Komatsu, Masayuki Chida, Kaoru Iwabuchi, M. Takeuchi, Hayao Yahagi, Naomi Takahashi, Keishi Otsuka, Yoshihiko Koseki, Makoto Morita, Tsuyoshi Shinozaki, Takeshi Ishizuka, Noriko Onoue, Nobuko Yamaguchi, Hiromasa Fujita, Atsushi Katoh, Shigeto Namiuchi, T. Sugie, K Saji, Toru Takii, Akihiko Sugimura, Junko Ohashi, Mitsumasa Fukuchi, Masaki Ogata, Toshiki Tanikawa, Osamu Kitamukai, Yorihiko Matsumoto, Koetsu Inoue, Jun-ichi Koyama, T. Tomioka, Hiroki Shioiri, Y. Ito, Hideyuki Kato, Chiaki Takahashi, Atsuo Kawana, Yasuhiko Sakata, Kaoru Ito, Mikio Nakayama, Koji Fukuda, Jun Takahashi, Satoshi Miyata, Koichiro Sugimura, K Sato, Yorihiko Matsumoto, Masaru Nakano, Takashi Shiroto, Rie Tsuburaya, Kotaro Nochioka, Hiroshi Yamamoto, Takeshi Aoki, Kiyotaka Hao, Makoto Miura, Masahide Kondo, Syunsuke Tatebe, Saori Yamamoto, Hodaka Suzuki, Kojiro Nishimiya, Nobuhiro Yaoita, M. Sugi, Yasumasa Yamamoto, Sunao Toda, Yutaka Minatoya, Yusuke Takagi, Yasushi Hasebe, T. Nihei, Kenichiro Hanawa, Koji Fukuda, Yasuhiko Sakata, Jun Takahashi, Satoshi Miyata, Kotaro Nochioka, Makoto Miura, Soichiro Tadaki, Ryoichi Ushigome, Takeshi Yamauchi, K Sato, Kunihiro Tsuji, Takashi Onose, R Abe, Chiharu Saga, Jun Suenaga, Yusuke Yamada, J. Kimura, Hirotaro Ogino, Ikuo OIKAWA, Sayumi Watanabe, M. Saga, Masakazu Washio, Kai Nagasawa, S. Nagasawa, Shuji Kotaka, Wataru Komatsu, Ryota Hashimoto, Yoshinobu Ikeno, Takahide Suzuki, Hiromi Hamada,

Cardiovascular and exercise physiology

We examined whether an additive treatment with an angiotensin receptor blocker, olmesartan, reduces the mortality and morbidity in hypertensive patients with chronic heart failure (CHF) treated with angiotensin-converting enzyme (ACE) inhibitors, β-blockers, or both. In this prospective, randomized, open-label, blinded endpoint study, a total of 1147 hypertensive patients with symptomatic CHF (mean age 66 years, 75% male) were randomized to the addition of olmesartan (n = 578) to baseline therapy vs. control (n = 569). The primary endpoint was a composite of all-cause death, non-fatal acute myocardial infarction, non-fatal stroke, and hospitalization for worsening heart failure. During a median follow-up of 4.4 years, the primary endpoint occurred in 192 patients (33.2%) in the olmesartan group and in 166 patients (29.2%) in the control group [hazard ratio (HR) 1.18; 95% confidence interval (CI), 0.96-1.46, P = 0.112], while renal dysfunction developed more frequently in the olmesartan group (16.8 vs. 10.7%, HR 1.64; 95% CI 1.19-2.26, P = 0.003). Subgroup analysis revealed that addition of olmesartan to combination of ACE inhibitors and β-blockers was associated with increased incidence of the primary endpoint (38.1 vs. 28.2%, HR 1.47; 95% CI 1.11-1.95, P = 0.006), all-cause death (19.4 vs. 13.5%, HR 1.50; 95% CI 1.01-2.23, P = 0.046), and renal dysfunction (21.1 vs. 12.5%, HR 1.85; 95% CI 1.24-2.76, P = 0.003). Additive use of olmesartan did not improve clinical outcomes but worsened renal function in hypertensive CHF patients treated with evidence-based medications. Particularly, the triple combination therapy with olmesartan, ACE inhibitors and β-blockers was associated with increased adverse cardiac events. This study is registered at clinicaltrials.gov-NCT00417222.