Objective    To evaluate the effects of perindopril and/or candesartan on the levels of endothelin-1 (ET-1)

interleukin-6 (IL-6) and matrix metal proteinase-9 (MMP-9) in serum and the left ventricular remodeling in patients with chronic heart failure (CHF).     Methods    Serum concentrations of ET-1

IL-6 and MMP-9 in normal controls (n=26) and patients with CHF (n=90)

who were randomized into perindopril group (4 mg/d of perindopril)

candesartan group (4 to 8 mg/d of candesartan) and combined group (4 mg/d of perindopril and 4 to 8 mg/d of candesartan) were measured before and after 8-week treatment. Left ventricular end-diastolic dimension (LVEDd) and left ventricular ejection fraction (LVEF) were measured by color Doppler echocardiography before and after the treatment.     Results    Before treatment

serum ET-1

IL-6 and MMP-9 levels in patients were significantly higher than those in normal subjects (110.31±18.83 vs 48.16±8.21

P0.01; 116.39±16.52 vs  62.47±10.78

P0.01; 248.31±65.42 vs 74.63±9.87

P0.01; respectively). Serum ET-1

IL-6 and MMP-9 levels were positively correlated with LVEDd (r=0.436， P0.01)

and negatively correlated with LVEF (r=-0.481

P0.01). After treatment

serum ET-1

IL-6 and MMP-9 levels and LVEDd in the combined group were significantly lower than those in the perindopril group and the candesartan group (63.52±17.17 ng/ml vs 79.24±12.81 ng/ml vs 75.47±16.23 ng/ml

P0.05; 82.58±9.47 ng/L vs 94.16±11.43 ng/L vs 91.46±10.27 ng/L

P0.05; 183.52±30.66 pg/ml vs 208.16±36.62 pg/ml vs 205.91±32.28 pg/ml

P0.05; 50.51±6.38 vs 55.73±7.85 vs 55.16±8.19

P0.05; respectively). On the contrary

LVEF in the combined group was significantly higher than that in the perindopril group and the candesartan group (49.21±8.59 vs 44.87±4.73 vs 46.17±6.36

P0.05). However

no such difference was noted between the perindopril group and the candesartan group (P0.05).     Conclusion    Perindopril combined with candesartan is remarkably superior to perindopril or candesartan alone in treating patients with CHF. The combined therapy can effectively decrease serum ET-1

IL-6 and MMP-9 levels and LVEDd while increasing LVEF.