Does Avapro help patients with heart failure?

Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction
Original source: New England Journal of Medicine Volume 359, Number 23
Authors: Barry M. Massie, M.D. (corresponding author), Peter E. Carson, M.D., John J. McMurray, M.D., Michel Komajda, M.D., Robert McKelvie, M.D., Michael R. Zile, M.D., Susan Anderson, M.S., Mark Donovan, Ph.D., Erik Iverson, M.S., Christoph Staiger, M.D., Agata Ptaszynska, M.D., for the I-PRESERVE Investigators
Publication date: online: November 11, 2008 print: December 4, 2008
DOI (digital document ID): 10.1056/NEJMoa0805450
Requires subscription? Yes
Publicly-available abstract: Yes

Synopsis:
There is a need to find a way of improving the outcome of patients with heart failure, whose left ventricles still function to some degree. The investigators wanted to know if irbesartan (brand names Avapro, Aprovel, Karvea) might serve that purpose.

Over 4000 patients, over the age of 60, and classified as having varying degrees of heart failure but at least 45% left ventricular evacuation fraction, were studied for just over 4 years. Some were given irbesartan and others were given a placebo. The investigators wanted to know how many of those patients had subsequent cardiovascular events requiring hospitalization, how many died from heart failure or cardiovascular causes, and how many died overall. The numbers of deaths were similar in both groups, though the number of hospitalizations for cardiovascular events were slightly lower in the group receiving the medication.

Because the numbers of deaths and cardiovascular events overall were not significantly different between the two groups, irbesartan is not considered to be effective for this application.

Reliability:
The study size is reasonable, and the subjects were followed for a reasonably-long period of time. Because of the ages of the subjects, the results may not be valid for younger patients.

The researchers are associated with accredited medical institutions in several countries. The article was published in peer-reviewed journal.

The research was sponsored by two pharmaceutical companies, Bristol Meyers Squibb (BMS) and Sanofi-Aventis. BMS and Sanofi-Aventis both manufacture and market Avapro and have a vested financial interest in its use for reasons in addition to the treatment high blood pressure.

Practical Applications:
Irbesartan has not been proven to be effective in preserving heart function among older patients with heart failure, but with preserved left ventricular function.

For further reading:
This is not the first time additional uses for Avapro have been considered. Avapro has also been studied as a drug with which to preserve kidney function in people with Type 2 diabetes. The following article is one of several published following that train of research:
The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes.

This synopsis was based on the abstract of the online preprint.