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Clinical outcomes according to baseline blood pressure in patients with a low ejection fraction in the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) Program.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2008 Dec 09; Vol. 52 (24), pp. 2000-7. - Publication Year :
- 2008
-
Abstract
- Objectives: This study sought to investigate the efficacy and tolerability of candesartan, according to baseline blood pressure (BP), in the 4,576 patients with a low ejection fraction (EF) (<or=0.40) in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) program.<br />Background: Hypotension is a predictor of poor prognosis in heart failure, yet many treatments shown to reduce morbidity and mortality lower blood pressure. This paradox creates a dilemma for physicians and may explain why low BP is reported as a reason for under-use of these agents.<br />Methods: The interaction between treatment and baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) was examined with patients divided into 6 SBP categories (<or=100, 101 to 110, 111 to 120, 121 to 130, 131 to 140 and >or=141 mm Hg) and 4 DBP categories (<or=60, 61 to 70, 71 to 80 and >or=81 mm Hg).<br />Results: Low SBP and DBP were associated with worse clinical outcomes. Baseline BP did not modify the effects of candesartan on clinical outcomes: the interaction p value between SBP category and treatment was 0.38 (0.22 for DBP category). For both placebo and candesartan, study drug discontinuation for adverse effects (especially hypotension) was highest in patients in the lowest baseline BP categories. However, the relative risk of discontinuation for hypotension, renal dysfunction, and hyperkalemia in the candesartan compared with placebo group was not increased in patients with a low baseline BP.<br />Conclusions: In patients with low EF heart failure, the relative risks and benefits of candesartan treatment were similar in patients with a low BP compared to those with a higher BP.
- Subjects :
- Aged
Biphenyl Compounds
Diastole
Female
Heart Failure mortality
Heart Failure physiopathology
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Factors
Systole
Time Factors
Treatment Outcome
Antihypertensive Agents therapeutic use
Benzimidazoles therapeutic use
Blood Pressure drug effects
Heart Failure drug therapy
Hypotension diagnosis
Stroke Volume drug effects
Tetrazoles therapeutic use
Ventricular Function, Left drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1558-3597
- Volume :
- 52
- Issue :
- 24
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 19055992
- Full Text :
- https://doi.org/10.1016/j.jacc.2008.09.011