Sepsis & septic shock · Choice of vasopressor
Angiotensin II for the Treatment of Vasodilatory Shock
| Design | Multicentre, double-blind, placebo-controlled randomised trial |
|---|---|
| Treatment | Intravenous angiotensin II |
| Control | Placebo |
| Population | 321 analysed patients with vasodilatory shock unresponsive to high-dose conventional vasopressors |
| Follow-up | 28 days |
| Primary endpoint | Mean arterial pressure response at hour 3 |
| Result | The primary blood pressure endpoint was reached by 114 of 163 (69.9%) receiving angiotensin II versus 37 of 158 (23.4%) on placebo — odds ratio 7.95. Death by day 28 occurred in 75 of 163 (46%) versus 85 of 158 (54%), hazard ratio 0.78. |
| Secondary endpoints | Cardiovascular SOFA score, 28-day mortality, adverse events |
Angiotensin II effectively increased blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors.
The trial authors, in the published abstract
The endpoint is blood pressure, not survival, and the authors say so plainly. It licensed a genuinely new vasopressor class for refractory shock without demonstrating that patients live longer — the same gap that VASST left for vasopressin.
Khanna A, English SW, Wang XS, et al. Angiotensin II for the Treatment of Vasodilatory Shock. N Engl J Med 2017 Aug 3;377(5):419-430.