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

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)14284-5

Cited by 1,557 publications

(637 citation statements)

References 18 publications

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“…Even in clinical trials, this is problematic; e.g. in the CHARM‐Alternative study, 59% of the candesartan group reached target dose 4. In the PARADIGM‐HF trial, 12% of the patients withdrew during the run‐in phase owing to adverse events of enalapril or sacubitril–valsartan 10.…”

Section: Discussionmentioning

confidence: 99%

“…Standard heart failure therapy is effective and refers to an angiotensin‐converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), a beta‐blocker, and a mineralocorticoid antagonist 2. Even though standard treatment reduces risk of death and heart failure hospitalization by up to 10–37%,3, 4, 5, 6, 7, 8, 9 mortality is high, and many patients suffer from severe symptoms on a daily basis. New and more effective heart failure treatments are needed.…”

Section: Introductionmentioning

confidence: 99%

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Eligibility of sacubitril–valsartan in a real‐world heart failure population: a community‐based single‐centre study

2018

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AimsThis study aims to investigate the eligibility of the Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor (ARNI) with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM‐HF) study to a real‐world heart failure population.Methods and resultsMedical records of all heart failure patients living within the catchment area of Umeå University Hospital were reviewed. This district consists of around 150 000 people. Out of 2029 patients with a diagnosis of heart failure, 1924 (95%) had at least one echocardiography performed, and 401 patients had an ejection fraction of ≤35% at their latest examination. The major PARADIGM‐HF criteria were applied, and 95 patients fulfilled all enrolment criteria and thus were eligible for sacubitril–valsartan. This corresponds to 5% of the overall heart failure population and 24% of the population with ejection fraction ≤ 35%. The eligible patients were significantly older (73.2 ± 10.3 vs. 63.8 ± 11.5 years), had higher blood pressure (128 ± 17 vs. 122 ± 15 mmHg), had higher heart rate (77 ± 17 vs. 72 ± 12 b.p.m.), and had more atrial fibrillation (51.6% vs. 36.2%) than did the PARADIGM‐HF population.ConclusionsOnly 24% of our real‐world heart failure and reduced ejection fraction population was eligible for sacubitril–valsartan, and the real‐world heart failure and reduced ejection fraction patients were significantly older than the PARADIGM‐HF population. The lack of data on a majority of the patients that we see in clinical practice is a real problem, and we are limited to extrapolation of results on a slightly different population. This is difficult to address, but perhaps registry‐based randomized clinical trials will help to solve this issue.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Eligibility of sacubitril–valsartan in a real‐world heart failure population: a community‐based single‐centre study

2018

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“…There is good evidence from CHARM-Alternative [13] in patients with CHF and VALIANT [14] in patients after acute myocardial infarction to show that ARBs are a good alternative in patients who cannot tolerate an ACE inhibitor. 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.…”

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

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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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“…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). The results of the recently published VALIANT study 83 were somewhat different from the Val-HeFT and CHARM studies.…”

Section: Heart Failurementioning

confidence: 99%

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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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

Cited by 1,557 publications

References 18 publications

Eligibility of sacubitril–valsartan in a real‐world heart failure population: a community‐based single‐centre study

Eligibility of sacubitril–valsartan in a real‐world heart failure population: a community‐based single‐centre study

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

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

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