All concepts, explanations, trials, and studies have been
re-written in plain English and may contain errors. I am
not a doctor
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Source: Expert Opin Pharmacother 2000 Jan;1(2):337-50
Title:Valsartan: a novel angiotensin type 1 receptor
      antagonist.
Author: Thurmann PA.

INTRODUCTION:
Valsartan is a highly selective, antagonist of the
angiotensin Type 1 (AT1) receptor. Studies confirm that
valsartan use eases the effects of angiotensin II - 
constricted blood vessels, excess cell growth, and
aldosterone release.

FINDINGS:
Valsartan is rapidly absorbed with maximum blood levels
occurring one to two hours after taking the drug.
Half-life is about 8 hours and most of the drug is
excreted in the stool. No dose adjustment is required
for patients with weak kidneys (creatinine clearance
over 10 ml/min). Dose should not be more than 80 mg
daily in patients with weak liver function. Valsartan
should not be used in patients with severe liver
dysfunction.

No important drug interactions have been seen yet.
Valsartan reduces blood pressure. Starting dose is
80 mg once daily. If required, the dose may either be
increased to 160 mg once daily or hydrochlorothiazide
may be added.

PMID: 11249553
========================================================

Source: Cardiology 1999;91 Suppl 1:19-22
Title: Improving outcomes in congestive heart failure:
       Val-HeFT. Valsartan in Heart Failure Trial.
Author: Cohn, JN.

INTRODUCTION:
Quality of life is best measured in trials by questionnaire.
Disease progression is measured by measuring mortality and
hospitalizations. We need to establish intermediate
markers for progression of heart disease that can be
substituted for hospitalizations and mortality. This will
improve effectiveness and shorten follow-up of clinical
trials.

DISCUSSION:
At present, multiple meds are required to get best
improvement in quality and length of life.Some drugs may
favorably affect one endpoint and affect the other
unfavorably. For example, beta-blockers may cause short-term
ill effects on quality of life but may slow disease
progression. Some inotropic drugs reduce symptoms but
shorten life expectancy. ACE) inhibitors improve quality of
life and mortality but do not completely block the effects
they are designed to block.

The Valsartan in Heart Failure Trial (Val-HeFT) is designed
to test the effectiveness and safety of the ARB valsartan
in combination with ACE inhibitors and all other standard
CHF drugs. The study is setup to detect a mortality benefit
and should establish the role of ARBs in this patient
group. When this trial and other ongoing studies are done,
we will be more able to define the role of ARBs in CHF
treatment.

PMID: 10449891
========================================================

Source: Eur J Heart Fail 2000 Dec;2(4):439-46
Title: Baseline demographics of the Valsartan Heart
       Failure Trial. Val-HeFT Investigators.
Authors: Cohn JN, Tognoni G, Glazer R, Spormann D.

INTRODUCTION:
The Valsartan Heart Failure Trial (Val-HeFT) is the first
large trial to study the ARB valsartan added to standard
therapy in CHF patients.

FINDINGS:
A total of 5010 patients with an ejection fraction under
40% have been randomized to take either 160 mg valsartan
BID or placebo. The study population has an average age
of 63 years and is 80% male, 90% white, 7% black, and 3%
Asian. Previous coronary heart disease is reported in 57%
of patients. ACE inhibitors are taken by 93% of patients,
diuretics by 86%, digoxin for 67%, and beta-blockers for
36%.

PMID: 11113722
========================================================

Source: Curr Hypertens Rep 2000 Aug;2(4):402-11
Title: Therapeutic trials comparing angiotensin converting
       enzyme inhibitors and angiotensin II receptor
       blockers.
Author: Elliott WJ.

INTRODUCTION:
ACE inhibitors and ARBs (angiotensin II receptor blockers)
can both be used for a broad variety of illnesses but may
also compete against each other as treatments for high
blood pressure, heart failure, and kidney impairment.

FINDINGS:
Many short-term studies have now compared ACE inhibitors
to ARBs. Most have focused on endpoints such as blood
pressure, kidney function, or cough. These studies have
generally shown that ARBs cause fewer side efffects but
otherwise the 2 drug classes have similar effectiveness.
The largest completed trial comparing ARBs to ACE
inhibitors is ELITE 2 (Evaluation of Losartan in the
Elderly). ELITE 2 did not confirm the results of a smaller
study - it did not show improvement in death or
hospitalization for heart failure with ARB use alone.
Many longer-term studies are under way, but most will
compare the combination against an ACE inhibitor alone.

PMID: 10981176
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