LANCET The angiotensin receptor blocker candesartan prolongs survival in patients with chronic heart failure regardless of whether they are taking an ACE inhibitor, a large study shows.
The addition of candesartan (Atacand) 32mg daily to an ACE inhibitor and beta blocker in patients with impaired left-ventricular function resulted in a 15% reduction in mortality and hospitalisation, researchers told the European Society of Cardiology congress in Vienna, Austria.
“Our findings are consistent with the evidence that angiotensin II continues to be produced despite chronic ACE inhibitor treatment,” the researchers said.
“Adding an angiotensin-receptor blocker to conventional treatment has clinical benefit.”
In the CHARM trial, sponsored by AstraZeneca, maker of Atacand, patients not receiving an ACE inhibitor because of intolerance, had a 23% reduction in cardiac death or hospitalisation for heart failure with candesartan.
For patients with preserved systolic function, the drug had a moderate impact in preventing hospital admissions, although there was no difference in cardiovascular death.
Professor Andrew Sindone, director of the heart failure unit at Sydney’s Concord Hospital and one of the trial investigators, said the findings supported adding an angiotensin-receptor blocker to conventional heart failure therapy.
“This sort of treatment is an additional tool to try to improve outcomes in this very sick population,” he said.
According to an editorial in the Lancet (6 September), candesartan would prevent one death per 63 patients treated for three years and one hospitalisation for first heart failure per 23 patients.
“The overall consistency of the results provides strong support for use of angiotensin-receptor blockers,” it said.
However, Dr Peter French, member of the clinical issues committee of the National Heart Foundation, greeted the results with caution.
“We should welcome the results as suggesting that another class of drug with which we are all familiar may have significant benefit … But we should not rush to judgment before the data is examined thoroughly.”
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