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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EHypertrophic cardiomyopathy (HCM) has a prevalence of 1 in every 500 individuals, making it the most frequently inherited cardiomyopathy, and it results in the fibrosis and hypertrophy of the left ventricle. This article discusses data from the Inhibition of the Renin Angiotensin System With Losartan in Patients With Hypertrophic Cardiomyopathy [INHERIT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01447654\u0026amp;atom=%2Fspmdc%2F14%2F52%2F18.atom\u0022\u003ENCT01447654\u003C\/a\u003E] trial, which investigated the use of losartan for HCM.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einflammatory disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003ELosartan treatment in patients with hypertrophic cardiomyopathy (HCM) did not alter left ventricular mass from baseline over 12 months compared with placebo. Anna Axelsson, MD, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark, presented data from the Inhibition of the Renin Angiotensin System With Losartan in Patients With Hypertrophic Cardiomyopathy [INHERIT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01447654\u0026amp;atom=%2Fspmdc%2F14%2F52%2F18.atom\u0022\u003ENCT01447654\u003C\/a\u003E] trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EHCM has a prevalence of 1 in every 500 individuals, making it the most frequently inherited cardiomyopathy, and it results in the fibrosis and hypertrophy of the left ventricle [Green JJ et al. \u003Cem\u003EJACC Cardiovasc Imaging.\u003C\/em\u003E 2012]. Data from in vivo studies performed in animal models and humans indicate that angiotensin receptor blockers (ARBs) may have a benefit on diastolic function, left ventricular mass, exercise capacity, and myocardial fibrosis [Shimada YJ et al. \u003Cem\u003EJACC Heart Fail.\u003C\/em\u003E 2013; Penicka M et al. \u003Cem\u003EJ Mol Diagn.\u003C\/em\u003E 2009; Araujo AQ et al. \u003Cem\u003EAm J Cardiol.\u003C\/em\u003E 2005]. The purpose of the INHERIT trial was to evaluate the effect of the ARB losartan on morphology and function of the left ventricle in patients with HCM.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the single-center, double-blind, phase 2 INHERIT trial, 133 adult patients with HCM were randomly assigned to receive losartan 100 mg\/d or placebo for 12 months. All patients were in sinus rhythm upon inclusion into the study. Patients were excluded if they had a left ventricular ejection fraction \u0026lt; 50%, significant valvular disease, blood pressure \u0026gt; 140\/90 mm Hg, an estimated glomerular filtration rate \u0026lt; 30 mL\/min per 1.73 m\u003Csup\u003E2\u003C\/sup\u003E, were currently taking an ARB or angiotensin-converting enzyme inhibitor, or had septal reduction treatment within 6 months. At baseline, the mean age was 52 years and 36% of participants were women. In the study, 64%, 30%, and 6% of patients were classified as having NYHA functional class I, II, and II, respectively. In addition, 43% of patients were identified as having a disease-causing genetic mutation.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary end point was change in left ventricular mass as determined by magnetic resonance imaging or computed tomography imaging. Secondary end points included changes in left ventricular maximal wall thickness, outflow tract gradient, and fibrosis, as well as changes in diastolic function, exercise tolerance, and symptoms of HCM. In the study, 93% of patients were compliant with study medication as determined by pill count.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/52\/18\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of Losartan on Left Ventricular Mass in Patients With Hypertrophic Cardiomyopathy\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-518326373\u0022 data-figure-caption=\u0022Effect of Losartan on Left Ventricular Mass in Patients With Hypertrophic Cardiomyopathy\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/52\/18\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/52\/18\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/52\/18\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15201\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EEffect of Losartan on Left Ventricular Mass in Patients With Hypertrophic Cardiomyopathy\u003C\/p\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003E95% CL, 95% confidence limit.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from A Axelsson, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EThere was no significant difference in change in left ventricular mass from baseline among patients who received losartan or placebo at 12 months (\u003Cem\u003EP\u003C\/em\u003E = .60). Similarly, there was no significant difference in change in maximal ventricular wall thickness, echocardiographic findings such as outflow gradient. In addition, a subgroup analysis demonstrated that there was no benefit with losartan treatment based on age, presence of a genetic mutation causing HCM, left ventricular outflow tract obstruction, maximal wall thickness, or history of myectomy or alcohol septal ablation.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe rate of adverse events (AEs) was similar among the losartan and placebo arms. AEs included sudden cardiac death, angioedema, hyperkalemia, renal impairment, worsening of NYHA functional class, and left ventricular outflow tract gradient. Seven patients discontinued therapy; unspecified symptoms led to discontinuation by 2 patients in the losartan arm and 1 patient in the placebo arm, 1 patient in the losartan arm discontinued treatment because of deterioration of renal function, angioedema caused 1 patient in the losartan arm to discontinue therapy, and 2 patients in the losartan arm were referred for septal reduction therapy and excluded from follow-up. In addition, 2 patients in the placebo arm died from sudden cardiac death.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn conclusion, Dr Axelsson stated that the results from the INHERIT trial indicate that losartan does not provide a benefit for left ventricular mass in patients with HCM; however, losartan treatment was safe and may be used, albeit with caution, for other indications in this population such as for treatment of hypertension.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/52\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzod01\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzod01\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}