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Reascher:In my opinion, at this time Losartan 150 mg is much better than 50 mg in terms of the edendpoints. There is a 10% decrease with 150 mg of Losartan in terms of reducing death or heart failure hospitalization. The HEAALstudy is the first to verify that 150 mg of Losartan has a therapeutic effect in the treatment of heart failure. Also, in Chinathe first time RAS blockade used to treat heart failure were ACE inhibitors but we have about 20% of patients with coughafter ACE inhibitor use, which is a relatively higher prevalence than seen in other populations. So in Chinese opulationswe also use ARBs. Before the HEAAL study we only used Valsartan or candesartan but now, after the HEAAL study, we can also choose 150 mg dose of Losartan in these kinds of patient populations.


Prof. Nissen:Really it just gives us another option but isn’t really a big change in what we are doing, giving us another choice.


Reascher:So you don’t think it would interfere with any of the guidelines for the treatment of heart failure?


Prof. Nissen:I don’t think so. The guidelines now in the United States say ACE first, followed by ARBs as a

secondarychoice since they are useful. We don’t have quite as much of a problem with cough as there is in China, but I can see how here having more options would be a good thing.


Reascher: Professor Nissen, what do you think is the trend for the treatment in heart failure strategies in the future?


Prof. Nissen:I think we are beginning to get to some limits here. There is no question that the combination of an ACE inhibitor or an ARB plus a β-blocker is very effective. We have not, however, seen much in terms of huge breakthroughs in the past few years. The problem of course is that it is a structural disease that is not easily reversible. I thought one of the most interesting presentations here.



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