Irbesartan in patients with heart failure and preserved ejection fraction

Abstract

Introduction: About 50% of patients have symptomatic heart failure (HF) with normal to near-normal ejection fraction (EF), a condition often referred to as HF with preserved EF (HFPEF). Prevalence of HFPEF increases with age, particularly among older women. Trial data on optimal treatment strategies for HFPEF are limited. Basic science studies have demonstrated that plasma renin activity is enhanced in patients with HF and normal EF, possibly inducing pathophysiologic hemodynamic and/or intrinsic tissue changes that predispose to HFPEF. Therefore, the Irbesartan in Patients With Heart Failure and Preserved Ejection Fraction (I-PRESERVE) study was designed to study the benefi ts of the angiotensin-receptor blocker irbesartan for older HFPEF patients. A smaller randomized controlled study, the Candesartan in Heart Failure–Assessment of Reduction in Mortality and Morbidity (CHARM)-Preserved trial [1], randomized 3023 HFPEF patients to show that the angiotensin-receptor blocker candesartan was associated with a nonsignifi cant reduction in its primary end point of cardiovascular death or HF hospitalizations.