Candesartan significantly lowered central pulse pressure (57 vs. 67 mmHg; P=0.043) and improved total arterial compliance compared to placebo in patients with chronic heart failure.
RCT (n=64)
Does candesartan improve pulsatile hemodynamics and large artery function in patients with chronic heart failure?
Candesartan improves large artery function and pulsatile hemodynamics in patients with chronic heart failure, providing a mechanistic basis for its cardiovascular benefits.
Absolute Event Rate: 57% vs 67%
p-value: p=0.043
BACKGROUND: Abnormal large artery function and increased pulsatile load are exacerbated by excess angiotensin-II acting through the AT1 receptor and contribute to the pathogenesis and progression of chronic heart failure (CHF). AIMS: To evaluate effects of the AT1 receptor blocker candesartan (N = 30) or placebo (N = 34) on pulsatile hemodynamics in participants with CHF in the CHARM program. METHODS AND RESULTS: Noninvasive hemodynamics were assessed following 6 and 14 months of treatment and averaged. Using calibrated tonometry and aortic outflow Doppler, characteristic impedance was calculated as the ratio of the change in carotid pressure and aortic flow in early systole. Total arterial compliance was calculated by the diastolic area method. Brachial blood pressure, cardiac output and peripheral resistance did not differ between groups. Lower central pulse pressure in the candesartan group (57+/-20 vs. 67+/-17 mmHg, P = 0.043) was accompanied by lower characteristic impedance (200+/-78 vs. 240+/-74 dyne s/cm5, P = 0.039) and higher total arterial compliance (1.87+/-0.70 vs. 1.47+/-0.48 ml/mmHg, P = 0.008). Similar favorable differences were seen when analyses were stratified for ejection fraction (0.40) and baseline angiotensin converting enzyme inhibitor use. CONCLUSIONS: Candesartan has a favorable effect on large artery function in patients with chronic heart failure.
Mitchell et al. (Tue,) conducted a rct in Chronic Heart Failure (n=64). Candesartan vs. Placebo was evaluated on Central pulse pressure (p=0.043). Candesartan significantly lowered central pulse pressure (57 vs. 67 mmHg; P=0.043) and improved total arterial compliance compared to placebo in patients with chronic heart failure.