Tags

Type your tag names separated by a space and hit enter

Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial.
Lancet 2003; 362(9386):767-71Lct

Abstract

BACKGROUND

Angiotensin II type 1 receptor blockers have favourable effects on haemodynamic measurements, neurohumoral activity, and left-ventricular remodelling when added to angiotensin-converting-enzyme (ACE) inhibitors in patients with chronic heart failure (CHF). We aimed to find out whether these drugs improve clinical outcome.

METHODS

Between March, 1999, and November, 1999, we enrolled 2548 patients with New York Heart Association functional class II-IV CHF and left-ventricular ejection fraction 40% or lower, and who were being treated with ACE inhibitors. We randomly assigned patients candesartan (n=1276, target dose 32 mg once daily) or placebo (n=1272). At baseline, 55% of patients were also treated with beta blockers and 17% with spironolactone. The primary outcome of the study was the composite of cardiovascular death or hospital admission for CHF. Analysis was done by intention to treat.

FINDINGS

The median follow-up was 41 months. 483 (38%) patients in the candesartan group and 538 (42%) in the placebo group experienced the primary outcome (unadjusted hazard ratio 0.85 [95% CI 0.75-0.96], p=0.011; covariate adjusted p=0.010). Candesartan reduced each of the components of the primary outcome significantly, as well as the total number of hospital admissions for CHF. The benefits of candesartan were similar in all predefined subgroups, including patients receiving baseline beta blocker treatment.

INTERPRETATION

The addition of candesartan to ACE inhibitor and other treatment leads to a further clinically important reduction in relevant cardiovascular events in patients with CHF and reduced left-ventricular ejection fraction.

Authors+Show Affiliations

University of Glasgow, Glasgow, UK. j.mcmurray@bio.gla.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

13678869

Citation

McMurray, John J V., et al. "Effects of Candesartan in Patients With Chronic Heart Failure and Reduced Left-ventricular Systolic Function Taking Angiotensin-converting-enzyme Inhibitors: the CHARM-Added Trial." Lancet (London, England), vol. 362, no. 9386, 2003, pp. 767-71.
McMurray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet. 2003;362(9386):767-71.
McMurray, J. J., Ostergren, J., Swedberg, K., Granger, C. B., Held, P., Michelson, E. L., ... Pfeffer, M. A. (2003). Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet (London, England), 362(9386), pp. 767-71.
McMurray JJ, et al. Effects of Candesartan in Patients With Chronic Heart Failure and Reduced Left-ventricular Systolic Function Taking Angiotensin-converting-enzyme Inhibitors: the CHARM-Added Trial. Lancet. 2003 Sep 6;362(9386):767-71. PubMed PMID: 13678869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. AU - McMurray,John J V, AU - Ostergren,Jan, AU - Swedberg,Karl, AU - Granger,Christopher B, AU - Held,Peter, AU - Michelson,Eric L, AU - Olofsson,Bertil, AU - Yusuf,Salim, AU - Pfeffer,Marc A, AU - ,, PY - 2003/9/19/pubmed PY - 2003/10/28/medline PY - 2003/9/19/entrez SP - 767 EP - 71 JF - Lancet (London, England) JO - Lancet VL - 362 IS - 9386 N2 - BACKGROUND: Angiotensin II type 1 receptor blockers have favourable effects on haemodynamic measurements, neurohumoral activity, and left-ventricular remodelling when added to angiotensin-converting-enzyme (ACE) inhibitors in patients with chronic heart failure (CHF). We aimed to find out whether these drugs improve clinical outcome. METHODS: Between March, 1999, and November, 1999, we enrolled 2548 patients with New York Heart Association functional class II-IV CHF and left-ventricular ejection fraction 40% or lower, and who were being treated with ACE inhibitors. We randomly assigned patients candesartan (n=1276, target dose 32 mg once daily) or placebo (n=1272). At baseline, 55% of patients were also treated with beta blockers and 17% with spironolactone. The primary outcome of the study was the composite of cardiovascular death or hospital admission for CHF. Analysis was done by intention to treat. FINDINGS: The median follow-up was 41 months. 483 (38%) patients in the candesartan group and 538 (42%) in the placebo group experienced the primary outcome (unadjusted hazard ratio 0.85 [95% CI 0.75-0.96], p=0.011; covariate adjusted p=0.010). Candesartan reduced each of the components of the primary outcome significantly, as well as the total number of hospital admissions for CHF. The benefits of candesartan were similar in all predefined subgroups, including patients receiving baseline beta blocker treatment. INTERPRETATION: The addition of candesartan to ACE inhibitor and other treatment leads to a further clinically important reduction in relevant cardiovascular events in patients with CHF and reduced left-ventricular ejection fraction. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/13678869/Effects_of_candesartan_in_patients_with_chronic_heart_failure_and_reduced_left_ventricular_systolic_function_taking_angiotensin_converting_enzyme_inhibitors:_the_CHARM_Added_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)14283-3 DB - PRIME DP - Unbound Medicine ER -