Clinical Trial: CHARM
The Charm-Alternative trial (n ¼ 2028) examined the effects of the ARB candesartan in patients with a reduced
left ventricular ejection fraction of less than 40% who were ACE inhibitor intolerant. Results of the study showed that after 33.7 months of follow up patients administered candesartan were 23% less likely to experience the primary end point: cardiovascular death or heart failure hospitaliza-tion compared with those who received standard heart failure medications with the exception of ACE inhibitors ( p¼ 0.0004).
CHARM examined the effect of candesartan on patients who were already on an ACE inhibitor, the majority of whom were on a beta-blocker. After 41 months of follow up patients receiving candesartan were 15% less likely to experience the primary end point compared with those given placebo (42% vs. 37.9; p ¼ 0.0011). This result occurred regardless of whether or not patients were on a beta-blocker and independent of the dose of ACE inhibitor used. When the combination of candesartan and an ACE inhibitor is administered, however, monitoring of serum creatinine and for hyperkalemia is necessary, particularly if spironolactone or eplerenone are used in the treatment regimen.

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