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Current perspectives for AT1-receptor blockers in the management of heart failure

Journal of Human Hypertension volume 16, pages S47–S51 (2002)Cite this article

Abstract

Despite improvements in therapy, long-term mortality remains high in patients with heart failure and thus there remains a need for new treatment strategies to reduce the burden of mortality and morbidity associated with this condition. AT1-receptor blockers represent a rational approach to the management of heart failure, and have been shown to have beneficial effects on heart failure symptoms and exercise tolerance. However, the two outcome trials reported to date have not shown conclusive evidence of improvements in mortality. The potential benefits of AT1-receptor blockers in heart failure are currently being investigated in several trials. The CHARM programme (Candesartan in Heart failure – Assessment of Reduction in Mortality and morbidity) is the largest heart failure trial so far. This comprises three trials: CHARM Alternative, in patients with left ventricular dysfunction who are intolerant to ACE inhibitors; CHARM Added, in patients with left ventricular dysfunction who are also receiving ACE inhibitors; CHARM Preserved, in patients with preserved left ventricular systolic function (ejection fraction >40%). The primary end point will be a composite of cardiovascular mortality and hospitalisation for the treatment of heart failure. Other trials are currently investigating the effects of AT1-receptor blockers when used as an alternative or in addition to ACE inhibitors. The CHARM programme, together with other studies, should clarify the role of these agents in the management of heart failure.

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References

  1. Willenbrock R, Philipp S, Mitrovic V, Dietz R . Neurohumoral blockade in CHF management JRAAS 2000 1 (Suppl 1): 24–30

    Google Scholar 

  2. Hansson L et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial Lancet 1999 353: 611–616

    Article  CAS  Google Scholar 

  3. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) N Engl J Med 1987 316: 1429–1435

  4. The SOLVD Investigators. Effect of enalapril on survival inpatients with reduced left ventricular ejection fractions and congestive heart failure N Engl J Med 1991 325: 293–302

  5. Cohn JN et al. A comparison of enalapril with hydralazine plus isosorbide dinitrate in heart failure N Engl J Med 1991 325: 303–310

    Article  CAS  Google Scholar 

  6. Latini R et al. Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin: systematic overview of individual data from 96,712 randomizedpatients. Angiotensin-converting Enzyme Inhibitor Myocardial Infarction Collaborative Group J Am Coll Cardiol 2000 35: 1801–1807

    Article  CAS  Google Scholar 

  7. Swedberg K, Kjekshus J, Snapinn S . Long-term survival in severe heart failure inpatients treated with enalapril. Ten year follow-up of CONSENSUS I Eur Heart J 1999 20: 136–139

    Article  CAS  Google Scholar 

  8. MacFadyen RJ et al. How often are angiotensin II and aldosterone concentrations raised during chronic ACE inhibitor treatment in cardiac failure? Heart 1999 82: 57–61

    Article  CAS  Google Scholar 

  9. Urata H et al. Angiotensin II-forming pathways in normal and failing human hearts Circ Res 1990 66: 883–890

    Article  CAS  Google Scholar 

  10. Riegger GAJ et al. Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil Circulation 1999 100: 2224–2230

    Article  CAS  Google Scholar 

  11. Packer M, Cohn JN . Consensus recommendations for the management of chronic heart failure Am J Cardiol 1999 83: 1A–38A

    Article  Google Scholar 

  12. Granger CB et al. Randomized trial of candesartan cilexetil in the treatment ofpatients with congestive heart failure and a history of intolerance to angiotensin-converting enzyme inhibitors Am Heart J 2000 139: 609–617

    Article  CAS  Google Scholar 

  13. Pitt B et al. Effect of losartan compared with captopril on mortality inpatients with symptomatic heart failure: randomised trial – the Losartan Heart Failure Survival Study ELITE II Lancet 2000 355: 1582–1587

    Article  CAS  Google Scholar 

  14. Horning B, Kohler C, Drexler H . Role of bradykinin in mediating vascular effects of angiotensin-converting enzyme inhibitors in humans Circulation 1997 95: 1115–1118

    Article  Google Scholar 

  15. Cohn JN, Tognoni G for the Valsartan Heart failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure N Engl J Med 2001 345: 1667–1675

    Article  CAS  Google Scholar 

  16. Brenner BM et al. Effects of losartan on renal and cardiovascular outcomes inpatients with type 2 diabetes and nephropathy N Engl J Med 2001 345: 861–869

    Article  CAS  Google Scholar 

  17. Swedberg K et al. Candesartan in Heart Failure – Assessment of Reduction in Mortality and Morbidity (CHARM): rationale and design J Cardiac Failure 1999 5: 276–282

    Article  CAS  Google Scholar 

  18. Dickstein K, Kjekshus J . Comparison of the effects of losartan and captopril inpatients after acute myocardial infarction: the OPTIMAAL trial design Am JCardiol 1999 83: 477–481

    Article  CAS  Google Scholar 

  19. Azizi M, Bernard MC, Ménard J . Pharmacodynamic-pharmacokinetic study of renin release during angiotensin II blockade J Hypertens 1999 17 (Suppl 3): S194

    Google Scholar 

  20. Belz GG et al. Candesartan cilexetil has the highest pharmacological potency of various AT1-receptor antagonists – assessed by the Schild regression technique in man J Hypertens 1999 17 (Suppl 3): S66

    Google Scholar 

  21. Meredith PA . Clinical comparative trials of angiotensin II type 1 (AT1)-receptor blockers Blood Press 2001 10 (Suppl 3): 11–17

    Article  Google Scholar 

  22. Remme WJ, Swedberg K . Guidelines for the diagnosis and treatment of chronic heart failure Eur Heart J 2001 22: 1527–1560

    Article  CAS  Google Scholar 

Download references

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  1. Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden

    K Swedberg

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Swedberg, K. Current perspectives for AT1-receptor blockers in the management of heart failure. J Hum Hypertens 16 (Suppl 3), S47–S51 (2002). https://doi.org/10.1038/sj.jhh.1001439

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