Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial

Granger, Christopher B.; McMurray, John J.V.; Yusuf, Salim; Held, Peter; Michelson, Eric L.; Olofsson, Bertil; Östergren, Jan; Pfeffer, Marc A.; Swedberg, Karl

doi:10.1016/s0140-6736(03)14283-3

Cited by 1,950 publications

(1,030 citation statements)

References 21 publications

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“…80 In a study similar to Val-HeFT, the 'CHARM-Added Trial', 2548 patients with heart failure and reduced left ventricular systolic function were randomized to either candesartan 32 mg/day (n ¼ 1276) or placebo (n ¼ 1272) in addition to their standard heart failure treatment and followed for 41 months. 81 The candesartan-based regimen resulted in a lower primary end point of total mortality, as well as any secondary end points other than the placebo-based regimen (P ¼ 0.01). In a substudy, 2025 patients intolerant to ACEIs were randomized to either candesartan 32 mg/day (n ¼ 1013) or placebo (n ¼ 1015) and followed for 33.7 months; 82 candesartan reduced the composite end point of cardiovascular death or hospital admissions for CHF by 30% compared to placebo (Po0.0001).…”

Section: Heart Failurementioning

confidence: 89%

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Chrysant

Desai

2005

J Hum Hypertens

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Poorly controlled hypertension is a major risk for cardiovascular morbidity and mortality, strokes, heart failure and renal failure. Despite these devastating complications, blood pressure control of p140/90 mmHg, which is above the current standard, is very poor worldwide, accounting for 34% of hypertensive patients in the United States, and 6% in other countries. The reasons for this poor control of blood pressure include lack of aggressive treatment by physicians, especially for the systolic blood pressure, drug selection and patient compliance. The blood pressure follows a circadian rhythm and is the highest between 0600 to 1200 h, when most complications occur. Long-acting drugs that extend their action to cover this vulnerable period are preferable, especially those that block the renin-angiotensin-aldosterone system, such as ACE inhibitors and angiotensin receptor blockers, and are the most effective in controlling blood pressure and preventing or reducing its cardiovascular and renal complications. With respect to the angiotensin receptor blockers, telmisartan has been demonstrated by several studies to be the longest acting among its class of drugs and to effectively prevent the early morning rise of blood pressure.

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Section: Heart Failurementioning

confidence: 89%

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Chrysant

Desai

2005

J Hum Hypertens

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“…Furthermore, CHARM-Added [15] showed that ARBs in addition to ACE inhibitors reduce cardiovascular mortality in patients with CHF and Val-HeFT [16] and VALIANT [14] showed that the combination reduced hospital admissions for worsening heart failure in patients with CHF and after acute myocardial infarction, respectively. However, studies comparing ACE inhibitors to ARBs have failed to show that ARBs are superior to ACE inhibitors.…”

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

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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.

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“…Chronic therapy with ACEI/ARB has been demonstrated to enhance cardiac function, reduce hospitalization, and increase survival in CHF 16, 17, 18, 19. However, a large percentage of patients with IDCM still progress to end‐stage HF despite the use of an ACEI/ARB.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of supramaximal titrated inhibition of renin‐angiotensin‐aldosterone system in idiopathic dilated cardiomyopathy

Sun

Gao

et al. 2015

ESC Heart Failure

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AimsThe optimal dosing strategies for blocking the renin‐angiotensin‐aldosterone system in idiopathic dilated cardiomyopathy (IDCM) are poorly known. We sought to determine the long‐term efficacy and safety of supramaximal titration of benazepril and valsartan in patients with IDCM.Methods and results480 patients with IDCM in New York Heart Association functional class II–IV and with left ventricular ejection fraction ≤35% were randomly assigned to extended‐release metoprolol (mean 152 mg/day, range 23.75–190), low‐dose benazepril (20 mg/day), low‐dose valsartan (160 mg/day), high‐dose benazepril (mean 69 mg/day, range 40–80), and high‐dose valsartan (mean 526 mg/day, range 320–640). After a median follow‐up of 4.2 years, high‐dose benazepril and valsartan, compared with their respective low dosages, resulted in 41% and 52% risk reduction in the primary endpoint of all‐cause death or admission for heart failure (P = 0.042 and 0.002), promoted functional improvement, and reversed remodelling as assessed by New York Heart Association classes, quality‐of‐life scores, and echocardiographic recording of left ventricular ejection fraction, left ventricular end‐diastolic volume, mitral regurgitation, and wall motion score index. Compared with metoprolol, high‐dose valsartan reduced risk for the primary endpoint by 46% (P = 0.006), whereas high‐dose benazepril and both low‐dose groups showed no significant difference. Major adverse events involved hypotension and renal impairment but were largely tolerated.ConclusionsSupramaximal doses of benazepril and valsartan were well tolerated and produced extra benefit than their low dosages in clinical outcome and cardiac reverse remodelling in patients with IDCM and modest‐severe heart failure. ClinicalTrials.gov identifier: NCT01917149.

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Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial

Cited by 1,950 publications

References 21 publications

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

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

Efficacy and safety of supramaximal titrated inhibition of renin‐angiotensin‐aldosterone system in idiopathic dilated cardiomyopathy

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