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Review: Optimising the use of Angiotensin Receptor Blockers in the Management of Chronic Heart Failure

Western Infirmary and University of Glasgow, Glasgow, UK, j.mcmurray{at}bio.gla.ac.uk

The Candesartan in Heart Failure Assessment of Reduction in Mortality and morbidity (CHARM) trial programme provided clear evidence of the efficacy of candesartan in the management of chronic heart failure (CHF) associated with reduced left ventricular (LV) systolic function. The morbidity and mortality benefits of candesartan were consistent irrespective of age, sex, ethnic origin or baseline heart failure therapy. Extensive safety analyses of the CHARM data have demonstrated that candesartan was well tolerated by patients receiving an angiotensin-converting enzyme (ACE) inhibitor (even at maximal doses) and beta-blocker, and by patients previously intolerant to an ACE inhibitor. They also demonstrated a low incidence of adverse effects, characteristic of drugs that inhibit the renin-angiotensin-aldosterone system

CHARM provides conclusive evidence confirming the role of candesartan in the management of CHF patients with LV systolic dysfunction.Treatment should be initiated early to ensure optimum outcome, starting at a low dose (4 mg once daily) and increasing to a target dose of 32 mg once daily. Routine monitoring of blood pressure and of serum creatinine and potassium is warranted.

Key Words: Candesartan • Angiotensin receptor blocker • Chronic heart failure • Safety • Efficacy

References

• Swedberg K., Cleland J., Dargie H. et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005). The Taskforce for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 2005;26:1115-40.[Free Full Text]
• McMurray JJV, 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; 362:767-71.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Granger CB, McMurray JJV, Yusuf S. et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet 2003;362:772-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Young JB, Dunlap ME, Pfeffer MA et al. Mortality and morbidity reduction with candesartan in patients with chronic heart failure and left ventricular systolic dysfunction. Results of the CHARM Low-Left Ventricular Ejection Fraction Trials. Circulation 2004;110:2618-26.[Abstract/Free Full Text]
• Pfeffer MA, Swedberg K., Granger CB et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362:759-66.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Cohn JN, Tognoni G., Valsartan heart failure trial investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001;345:1667-75.[Abstract/Free Full Text]
• O'Meara E., Solomon S., McMurray J. et al. Effect of candesartan on New York Heart Association functional class. Results of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J 2004;25:1920-6.[Abstract/Free Full Text]
• McMurray J., Cohen-Solal A., Dietz R. et al. Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: putting guidelines into practice. Eur J Heart Failure 2005;7:710-21.[Abstract/Free Full Text]

Journal of Renin-Angiotensin-Aldosterone System, Vol. 6, No. 2 suppl, S2-S5 (2005)
DOI: 10.1177/14703203050060020201


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by McMurray, J. Search for Related Content PubMed Articles by McMurray, J. Social Bookmarking                         What's this?