Comparison of Candesartan, Enalapril, and Their Combination in Congestive Heart Failure

McKelvie, Robert S.; Yusuf, Salim; Pericak, Dan; Avezum, Álvaro; Burns, Robert J.; Probstfield, Jeffrey L.; Tsuyuki, Ross T.; White, Michel; Rouleau, Jean L.; Latini, Roberto; Maggioni, Aldo P.; Young, James B.; Pogue, Janice

doi:10.1161/01.cir.100.10.1056

Cited by 794 publications

(174 citation statements)

References 13 publications

Supporting

Mentioning

166

Contrasting

Unclassified

Order By: Relevance

“…However, mortality was neither a primary nor a secondary endpoint in ELITE. In the RESOLVD [18] study, there was a trend towards better survival with enalapril compared to candesartan (20/327 (6.1%) deaths in the candesartan group compared to 4/109 (3.7%) in the enalapril group, odds ratio 1.71, 95% confidence interval 0.57, 5.12). ELITE II [7], the largest study to date comparing ACE inhibitors and ARBs in CHF using mortality as the primary endpoint, found that the two classes of drugs were similar in their reduction of mortality (hazard ratio comparing losartan to captopril 1.13, 95% confidence interval 0.95, 1.35).…”

Section: Discussionmentioning

confidence: 99%

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Hudson

Rahme

Behlouli

et al. 2007

European J of Heart Fail

100

View full text Add to dashboard Cite

Background: Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to improve survival in patients with congestive heart failure (CHF). We wish to determine whether there are sex-related differences in the optimal treatment of congestive heart failure. Methods: Using administrative databases, all patients N >= 65 years of age discharged with a diagnosis of CHF between January 1998 and March 2003 and who filled a prescription for an ARB or an ACE inhibitor within 90 days of discharge were identified. Time to all-cause death in women and men on ACE inhibitors or ARBs was compared. Results: There were 10,223 women (8627 ACE inhibitors and 1596 ARBs) and 9475 men (8484 ACE inhibitors and 991 ARBs). Hypertension was more common in women (50.1%) than men (33.1%). Women on ARBs had better survival than those on ACE inhibitors (adjusted hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.59, 0.80). There was no difference in survival in men prescribed ARBs compared to ACE inhibitors (HR 1.10, 95% CI 0.95, 1.30). Conclusion: These sex differences in treatment-related outcome are important but should be confirmed in a randomized trial before ARBs are preferentially prescribed to women with CHF.

show abstract

Section: Discussionmentioning

confidence: 99%

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Hudson

Rahme

Behlouli

et al. 2007

European J of Heart Fail

100

View full text Add to dashboard Cite

show abstract

“…In addition, several intervention trials have demonstrated that ACEI and/or ARB can decrease morbidity and mortality in CHF [29][30][31], but the a-blocker, doxazosin, one of the most popular a-blockers, was not considered to be a good application for CHF in the ALLHAT trial [32]. As for the change in the plasma BNP level, McKelvie et al have reported that candesartan could decrease the plasma BNP level in the combination with ACEI in patients with CHF [33]. Latini et al have recently shown that valsartan alone, one of the ARBs, could decrease the plasma BNP level at 4 months in patients with symptomatic chronic CHF [34].…”

Section: Discussionmentioning

confidence: 99%

Characterization of Plasma Brain Natriuretic Peptide Level in Patients with Type 2 Diabetes

et al. 2005

View full text Add to dashboard Cite

Abstract. This study investigates whether the plasma brain natriuretic peptide (BNP) level is increased by the clinical traits of diabetes, including its complications, and whether these levels are affected by the presence of other combined diseases such as hypertension, hyperlipidemia, and coronary heart disease (CHD) in patients with diabetes. In 223 patients with Type 2 diabetes, the mean value of plasma BNP reached 32.3 ± 4.1 pg/mL. The levels significantly increased with age, hypertension, and CHD but not with the duration of diabetes, HbA1c level, or hyperlipidemia. With regard to the type of therapy, the BNP levels were significantly lower in the combinations of both sulfonylurea and metformin and sulfonylurea and pioglitazone than those in insulin alone. In addition, the BNP levels in the group with diabetic complications, including retinopathy and nephropathy, and macroalbuminuria were significantly elevated in comparison with those without these complications and macroalbuminuria. Interestingly, however, no difference was observed between these groups after removal of the values in patients with CHD. These results have clarified that the plasma BNP levels in diabetic patients could increase only by the progression of macrovascular diseases, such as CHD, but not by the current diabetic control or diabetic microvascular complications.

show abstract

“…This phenomenon is an important issue during a long-term treatment with ACE-I and ARB. 1,[5][6][7][8][9][10][11] Although the mechanisms of ALD breakthrough remain obscure, there was no apparent reduction of the left ventricular mass index (LVMI) in patients with ALD breakthrough(+) during the administration of ACE-I. 8 Aldosterone production in the adrenal gland is mediated mainly by the T-type calcium channel in vitro.…”

Section: Introductionmentioning

confidence: 99%

Long-term effect of efonidipine therapy on plasma aldosterone and left ventricular mass index in patients with essential hypertension

et al. 2009

View full text Add to dashboard Cite

A certain percentage of aldosterone (ALD) breakthrough generally occurs in patients with hypertension and chronic heart failure and is an important issue during long-term treatment with angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB). It has been reported that efonidipine decreases the plasma levels of ALD. However, the long-term effects of efonidipine on the plasma levels of ALD and the left ventricular mass index (LVMI) remain unknown in patients with hypertension. Sixty stable outpatients with essential hypertension who had received amlodipine and ACE-I or ARB for more than 1 year were randomized into two groups (amlodipine group (n¼30): continuous amlodipine treatment at a stable dose; efonidipine group (n¼30): amlodipine (5 mg day À1 ) was changed to efonidipine at a dose of 40 mg day À1 ). There was no difference in their baseline characteristics including the LVMI and plasma levels of ALD. In the amlodipine group, there were no significant changes in blood pressure, LVMI or plasma levels of ALD for 18 months. In the efonidipine group, blood pressure did not change after replacement of amlodipine with efonidipine, although there was a significant decrease in the plasma levels of ALD after 6 months. The decrease in ALD was sustained for 18 months and LVMI was significantly decreased after 18 months (121 ± 25 vs. 114 ± 21 g m À2 , Po0.05). There was a significant correlation between the changes in LVMI and % changes of ALD in the efonidipine group. These findings indicate that the effect of efonidipine on the suppression of plasma ALD was sustained for at least 18 months and that long-term efonidipine therapy decreases LVMI in patients with essential hypertension. INTRODUCTIONRecent clinical trials have shown that inhibiting the biological actions of aldosterone (ALD) using an ALD blocker alone or in combination with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) is reported to be a useful add-on therapy in hypertensive patients, reducing the incidence of cardiovascular events among patients with chronic heart failure (CHF). 1,2 Therefore, to prevent cardiovascular disease, targeting ALD synthesis and release may be clinically important. One of the major incentives for implementing the RALES and EPHESUS trial was the investigation of the ALD breakthrough phenomenon 3,4 in which ACE-I does not reliably induce significant decreases in plasma ALD levels. Therefore, in a certain percentage of patients with hypertension or CHF, ALD breakthrough generally occurs. This phenomenon is an important issue during a long-term treatment with ACE-I and ARB. 1,[5][6][7][8][9][10][11] Although the mechanisms of ALD breakthrough remain obscure, there was no apparent reduction of the left ventricular mass index (LVMI) in patients with ALD breakthrough(+) during the administration of ACE-I. 8 Aldosterone production in the adrenal gland is mediated mainly by the T-type calcium channel in vitro. 12 Recently, it has been reported that efonidipine, a...

show abstract

Comparison of Candesartan, Enalapril, and Their Combination in Congestive Heart Failure

Abstract: Candesartan alone was as effective, safe, and tolerable as enalapril. The combination of candesartan and enalapril was more beneficial for preventing left ventricular remodeling than either candesartan or enalapril alone.

Cited by 794 publications

References 13 publications

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Characterization of Plasma Brain Natriuretic Peptide Level in Patients with Type 2 Diabetes

Long-term effect of efonidipine therapy on plasma aldosterone and left ventricular mass index in patients with essential hypertension

Contact Info

Product

Resources

About