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For heart failure patients with preserved left ventricular ejection fraction (LVEF), irbesartan therapy did not improve clinical outcomes, according to results published in the New England Journal of Medicine. The Irbesartan in Heart Failure with Preserved Ejection Fraction Study (I-PRESERVE) enrolled 4128 patients in 25 countries. Heart failure patients with LVEF >= 45% were randomized to either 75mg irbesartan or placebo daily, with the dosage doubling every 1-2 weeks. Irbesartan, an angiotensin II receptor antagonist, is used as a treatment for hypertension. Researchers hypothesized that because the renin-angiotensin-aldosterone system plays a role in heart failure, irbesartan therapy might provide a benefit to the 50% of heart failure patients with a preserved LVEF. At a mean follow-up of 49.5 months, however, there was no significant difference in rates of all-cause death or cardiovascular-related hospitalization between drug and placebo groups (100.4/1000 patient-years vs 105.4/1000 patient-years, p=0.35). Researchers suggested that the negative results may have been due to a suboptimal drug dosage, a high rate of drug discontinuation (34%), as well as high rates of patients taking other renin-angiotensin-aldosterone system inhibitors. (NEJM by Barrie Massie et al.)
