Long-term combined therapy with an angiotensin type I receptor blocker and an angiotensin converting enzyme inhibitor prolongs survival in dilated cardiomyopathy

Jpn Heart J. 2002 Sep;43(5):531-43. doi: 10.1536/jhj.43.531.


The efficacy of ACE inhibitors (ACEIs) in the treatment of chronic heart failures is well documented. However, ACEIs may provide incomplete blockade of the renin-angiotensin system (RAS) because of the alternative pathways for angiotensin II (All) production. We hypothesized that more complete blockade of RAS by adding an AT1 receptor blocker (ARB) may have greater potential to decrease mortality associated with heart failure and improve cardiac function than monotherapy with ACEIs. The objective of this study was to evaluate the effect of combined therapy on cardiac functions and survival in cardiomyopathic hamsters. Male cardiomyopathic hamsters (BIO TO2) were administered either placebo (group C), enalapril (30 mg/kg/day) (group E), or enalapril (30 mg/kg/day) + valsartan (500 mg/ kg/day) (group EV), starting at the age of 6 weeks. Kaplan-Meier analysis was performed to assess the differences in survival. Cardiac functions were evaluated by echocardiogram and cardiac catheterization. Group EV showed significant increases in fractional shortening, LV dP/dTmax, and deceleration time, and showed significant decreases in left ventricular diastolic dimension, LV dP/dTmin, and early diastolic mitral velocity/atrial systolic velocity. Treatment with enalapril resulted in longer survival compared with placebo. Moreover, life expectancy (median probability of survival: 433 days) increased significantly in group EV compared with group E (P<0.05) as well as group C (P<0.001). It is concluded that combined therapy improved cardiac function and survival compared to placebo or enalapril monotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiotensin I / administration & dosage
  • Angiotensin I / antagonists & inhibitors*
  • Angiotensin Receptor Antagonists*
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
  • Animals
  • Cardiomyopathy, Dilated / diagnostic imaging
  • Cardiomyopathy, Dilated / drug therapy*
  • Cardiomyopathy, Dilated / physiopathology
  • Cell Count
  • Chronic Disease
  • Cricetinae
  • Drug Therapy, Combination
  • Echocardiography, Doppler
  • Enalapril / administration & dosage
  • Fibrosis
  • Hemodynamics / drug effects
  • Male
  • Myocytes, Cardiac / pathology
  • Random Allocation
  • Receptors, Angiotensin / administration & dosage
  • Renin-Angiotensin System / drug effects


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Receptors, Angiotensin
  • Enalapril
  • Angiotensin I