Valsartan in early-stage hypertrophic cardiomyopathy: a randomized phase 2 trial

• Published in: Nature medicine Vol. 27; no. 10; pp. 1818 - 1824
• Main Authors: Ho, Carolyn Y., Day, Sharlene M., Axelsson, Anna, Russell, Mark W., Zahka, Kenneth, Lever, Harry M., Pereira, Alexandre C., Colan, Steven D., Margossian, Renee, Murphy, Anne M., Canter, Charles, Bach, Richard G., Wheeler, Matthew T., Rossano, Joseph W., Owens, Anjali T., Bundgaard, Henning, Benson, Lee, Mestroni, Luisa, Taylor, Matthew R. G., Patel, Amit R., Wilmot, Ivan, Thrush, Philip, Vargas, Jose D., Soslow, Jonathan H., Becker, Jason R., Seidman, Christine E., Lakdawala, Neal K., Cirino, Allison L., Burns, Kristin M., McMurray, John J. V., MacRae, Calum A., Solomon, Scott D., Orav, E. John, Braunwald, Eugene
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.10.2021; Nature Publishing Group
• Subjects: 631/208; 692/308/2779/777; 692/699/75/74/1540; Adolescent; Adult; Angiotensin; Angiotensin II; Biomedical and Life Sciences; Biomedicine; Calcium-binding protein; Cancer Research; Cardiomyopathy; Cardiomyopathy, Hypertrophic; Cardiomyopathy, Hypertrophic - drug therapy; Cardiomyopathy, Hypertrophic - physiopathology; Care and treatment; Clinical trials; Confidence intervals; Congestive heart failure; Diagnosis; Double-Blind Method; Female; Fibrosis; Heart - drug effects; Heart - physiopathology; Heart Failure - drug therapy; Heart Failure - physiopathology; Humans; Hypertrophy; Infectious Diseases; Male; Metabolic Diseases; Middle Aged; Molecular Medicine; Neurosciences; Placebos; Receptors; Serum levels; Structure-function relationships; Testing; Troponin; Troponin T; Valsartan; Valsartan - administration & dosage; Valsartan - adverse effects; Ventricle; Young Adult; United States
• ISSN: 1078-8956; 1546-170X
• DOI: 10.1038/s41591-021-01505-4

Hypertrophic cardiomyopathy (HCM) is often caused by pathogenic variants in sarcomeric genes and characterized by left ventricular (LV) hypertrophy, myocardial fibrosis and increased risk of heart failure and arrhythmias. There are no existing therapies to modify disease progression. In this study, we conducted a multi-center, double-blind, placebo-controlled phase 2 clinical trial to assess the safety and efficacy of the angiotensin II receptor blocker valsartan in attenuating disease evolution in early HCM. In total, 178 participants with early-stage sarcomeric HCM were randomized (1:1) to receive valsartan (320 mg daily in adults; 80–160 mg daily in children) or placebo for 2 years ( NCT01912534 ). Standardized changes from baseline to year 2 in LV wall thickness, mass and volumes; left atrial volume; tissue Doppler diastolic and systolic velocities; and serum levels of high-sensitivity troponin T and N-terminal pro-B-type natriuretic protein were integrated into a single composite z -score as the primary outcome. Valsartan ( n  = 88) improved cardiac structure and function compared to placebo ( n  = 90), as reflected by an increase in the composite z -score (between-group difference +0.231, 95% confidence interval (+0.098, +0.364); P  = 0.001), which met the primary endpoint of the study. Treatment was well-tolerated. These results indicate a key opportunity to attenuate disease progression in early-stage sarcomeric HCM with an accessible and safe medication. In a randomized phase 2 clinical trial, the angiotensin receptor blocker valsartan improved cardiac structure and function in patients with early-stage hypertrophic cardiomyopathy, a condition for which there are no effective therapies for modifying disease progression.