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Angiotensin receptor blockade with candesartan in heart failure: findings from the Candesartan in Heart failure--assessment of reduction in mortality and morbidity (CHARM) programme.
J Hypertens Suppl 2006; 24(1):S3-7JH

Abstract

BACKGROUND

Randomized clinical trials in patients with chronic heart failure and reduced left ventricular ejection fraction (LVEF) have demonstrated the life-saving and symptomatic benefits of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and, in more selected patients, spironolactone. Despite these major advancements, the prevalence of heart failure continues to increase mainly as a consequence of aging populations. The development of angiotensin II type 1 receptor blockers (ARBs) provides a pharmacologically distinct mechanism of inhibiting the renin-angiotensin-aldosterone system. ARBs offer the potential to produce further clinical improvements for patients with heart failure above and beyond ACE inhibitors, as well as an alternative for those intolerant to an ACE inhibitor.

METHODS

The Candesartan in Heart failure--Assessment of Reduction in Mortality and morbidity (CHARM) programme was designed as three parallel, randomized, double-blind, placebo-controlled clinical trials comparing candesartan with placebo in three different but complementary populations of patients with symptomatic heart failure.

RESULTS

In patients with intolerance to an ACE inhibitor and an LVEF of 40% or less (the CHARM-Alternative trial), candesartan reduced cardiovascular mortality and hospitalizations for heart failure by 23% (P < 0.001). In patients with an LVEF of 40% or less treated with an ACE inhibitor (the CHARM-Added trial), candesartan reduced cardiovascular death and hospitalization for chronic heart failure by 15% (P = 0.011). In patients with a LVEF greater than 40% (the CHARM-Preserved trial), hospitalizations for heart failure and new-onset diabetes were significantly reduced.

CONCLUSION

The CHARM programme, together with evidence from mechanistic studies and from other large trials with ARBs, constitutes a firm basis for including an ARB in the therapeutic arsenal in the treatment for chronic heart failure.

Authors+Show Affiliations

Department of Medicine, Karolinska University Hospital, Stockholm, Sweden. jan.ostergren@karolinska.se

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16601570

Citation

Ostergren, Jan B.. "Angiotensin Receptor Blockade With Candesartan in Heart Failure: Findings From the Candesartan in Heart Failure--assessment of Reduction in Mortality and Morbidity (CHARM) Programme." Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, vol. 24, no. 1, 2006, pp. S3-7.
Ostergren JB. Angiotensin receptor blockade with candesartan in heart failure: findings from the Candesartan in Heart failure--assessment of reduction in mortality and morbidity (CHARM) programme. J Hypertens Suppl. 2006;24(1):S3-7.
Ostergren, J. B. (2006). Angiotensin receptor blockade with candesartan in heart failure: findings from the Candesartan in Heart failure--assessment of reduction in mortality and morbidity (CHARM) programme. Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, 24(1), pp. S3-7.
Ostergren JB. Angiotensin Receptor Blockade With Candesartan in Heart Failure: Findings From the Candesartan in Heart Failure--assessment of Reduction in Mortality and Morbidity (CHARM) Programme. J Hypertens Suppl. 2006;24(1):S3-7. PubMed PMID: 16601570.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Angiotensin receptor blockade with candesartan in heart failure: findings from the Candesartan in Heart failure--assessment of reduction in mortality and morbidity (CHARM) programme. A1 - Ostergren,Jan B, PY - 2006/4/8/pubmed PY - 2006/7/6/medline PY - 2006/4/8/entrez SP - S3 EP - 7 JF - Journal of hypertension. Supplement : official journal of the International Society of Hypertension JO - J Hypertens Suppl VL - 24 IS - 1 N2 - BACKGROUND: Randomized clinical trials in patients with chronic heart failure and reduced left ventricular ejection fraction (LVEF) have demonstrated the life-saving and symptomatic benefits of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and, in more selected patients, spironolactone. Despite these major advancements, the prevalence of heart failure continues to increase mainly as a consequence of aging populations. The development of angiotensin II type 1 receptor blockers (ARBs) provides a pharmacologically distinct mechanism of inhibiting the renin-angiotensin-aldosterone system. ARBs offer the potential to produce further clinical improvements for patients with heart failure above and beyond ACE inhibitors, as well as an alternative for those intolerant to an ACE inhibitor. METHODS: The Candesartan in Heart failure--Assessment of Reduction in Mortality and morbidity (CHARM) programme was designed as three parallel, randomized, double-blind, placebo-controlled clinical trials comparing candesartan with placebo in three different but complementary populations of patients with symptomatic heart failure. RESULTS: In patients with intolerance to an ACE inhibitor and an LVEF of 40% or less (the CHARM-Alternative trial), candesartan reduced cardiovascular mortality and hospitalizations for heart failure by 23% (P < 0.001). In patients with an LVEF of 40% or less treated with an ACE inhibitor (the CHARM-Added trial), candesartan reduced cardiovascular death and hospitalization for chronic heart failure by 15% (P = 0.011). In patients with a LVEF greater than 40% (the CHARM-Preserved trial), hospitalizations for heart failure and new-onset diabetes were significantly reduced. CONCLUSION: The CHARM programme, together with evidence from mechanistic studies and from other large trials with ARBs, constitutes a firm basis for including an ARB in the therapeutic arsenal in the treatment for chronic heart failure. SN - 0952-1178 UR - https://www.unboundmedicine.com/medline/citation/16601570/Angiotensin_receptor_blockade_with_candesartan_in_heart_failure:_findings_from_the_Candesartan_in_Heart_failure__assessment_of_reduction_in_mortality_and_morbidity__CHARM__programme_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=16601570.ui DB - PRIME DP - Unbound Medicine ER -