Researchers said a new clinical study provides evidence that treatment of heart attack patients with the angiotensin receptor blocker valsartan is as effective as the proven dose of the angiotensin-converting enzyme (ACE) inhibitor captopril.
In the 14,703-patient Valsartan in Acute Myocardial Infarction Trial (VALIANT), Dr. Marc Pfeffer, Ph.D., professor of medicine at the Harvard Medical School in Boston, Massachusetts, and his colleagues determined that after three years, both valsartan and captopril had similar effects on mortality.
"We did attempt to prove that one was better than the other, but we didn’t prove that," Pfeffer said. "We did prove that these drugs are as good as each other."
VALIANT was a multi-center, well-designed study comparing the efficacy and safety of long-term treatment with valsartan, captopril and their combination in high-risk patients after a heart attack or myocardial infarction (MI).
Valsartan belongs to a class of drugs called angiotensin receptor blocker (ARB), while captopril is classified as an angiotensin converting enzyme (ACE) inhibitor.
The use of ACE inhibitors has not been optimized in clinical practice because of their bothersome side-effects, specifically itchiness of the throat and coughing.
"I believe that the results of this trial will change clinical practice," said Dr. Raymond Gibbons, the Arthur M. and Gladys D. Gray professor of medicine at the Mayo Medical School in Rochester, Minnesota.
He said that up to now when a patient on an ACE-inhibitor experienced cough that required change in dose – which occurred in about five percent of the time in VALIANT and has also been shown in clinical practice – he didn’t have a treatment alternative. Now, he said, he has clinical evidence that valsartan can be used as an alternative product.
Pfeffer said that while other angiotensin receptor blockers might have similar class effects in treating patients with heart attacks, only the clinical trial offers doctors instruction on what dose of the drug works in these patients.
The local medical community was immediately informed of the results as presented by the main authors of the study in Orlando via a wide-screen webcast at the Intercontinental Manila on Nov. 11, and at the Cebu Marriott Hotel on Nov. 13. Dr. Adelaida Iboleon-Dy chaired the Manila webcast, while Dr. Jane Galang chaired the Cebu event.
According to Josephine Padua, senior product manager, the VALIANT trial provided additional information on the benefits of the ARB valsartan beyond blood pressure lowering, which should make doctors confident in prescribing it to patients following a heart attack.