Journal Article

Relationship of dose of background angiotensin-converting enzyme inhibitor to the benefits of candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)–Added trial

Granger, Christopher B., Swedberg, Karl, Olofsson, Bertil, Michelson, Eric L., Young, James B., Yusuf, Salim, Pfeffer, Marc A., Dunlap, Mark E., McMurray, John J.V., Hainer, James, Earle, Steven, Östergren, Jan

2006

Overview

Whether an angiotensin receptor blocker is of benefit when added to a full dose of angiotensin-converting enzyme (ACE) inhibitor in heart failure (HF) is uncertain. The effect of candesartan, compared with placebo, in 2548 patients randomized in the CHARM-Added trial was analyzed according to (i) ACE inhibitor dose at baseline, (ii) ACE inhibitor dose during follow-up, and (iii) combination treatment with ACE inhibitor and β-blocker at baseline. The main outcome was the composite of cardiovascular death or HF hospitalization. The benefit of candesartan was not modified by the dose of ACE inhibitor. In all patients (n = 2548), the candesartan/placebo hazard ratio (HR) for the primary outcome was 0.85 (95% CI 0.75-0.96). In patients taking a guideline recommended dose of ACE inhibitor at baseline (n = 1291), this HR was 0.79 (95% CI 0.67-0.95; interaction P value .26). In patients taking a Food and Drug Administration–designated maximum dose of ACE inhibitor (n = 529), this HR was 0.75 (95% CI 0.57-0.98; interaction P value .29). The benefit of candesartan was preserved in patients taking β-blockers in addition to a higher dose of ACE inhibitor and in patients maintaining a high dose of ACE inhibitor throughout follow-up. These clinical findings support the pharmacologic evidence that ACE inhibitors and angiotensin receptor blockers have distinct mechanisms of action and show that their combined use improves outcomes in patients with HF more than an evidence-based dose of ACE inhibitor alone.

• Publisher: Mosby, Inc,Elsevier,Elsevier Limited
• Subject: ACE inhibitors / Aged / Angiotensin II Type 1 Receptor Blockers - adverse effects / Angiotensin II Type 1 Receptor Blockers - therapeutic use / Angiotensin II Type 1 Receptor Blockers/adverse effects/therapeutic use / Angiotensin-Converting Enzyme Inhibitors - administration & dosage / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Angiotensin-Converting Enzyme Inhibitors/administration / Benzimidazoles - adverse effects / Benzimidazoles - therapeutic use / Benzimidazoles/adverse effects/therapeutic use / Biological and medical sciences / Cardiology and Cardiovascular Disease / Cardiology. Vascular system / Combination / Congestive/drug therapy/mortality/therapy / dosage/therapeutic use / Dose-Response Relationship / Dose-Response Relationship, Drug / Drug / Drug dosages / Drug Therapy / Drug Therapy, Combination / Enzymes / FDA approval / Female / Heart / Heart attacks / Heart Failure / Heart Failure - drug therapy / Heart Failure - mortality / Heart Failure - therapy / Heart failure, cardiogenic pulmonary edema, cardiac enlargement / Hospitalization - statistics & numerical data / Humans / Hypertension / Kardiologi och kardiovaskulära sjukdomar / Male / Medical sciences / Middle Aged / Mortality / Proportional Hazards Models / Randomized Controlled Trials / Randomized Controlled Trials as Topic / Statistical methods / Tetrazoles - adverse effects / Tetrazoles - therapeutic use / Tetrazoles/adverse effects/therapeutic use