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Effects of candesartan cilexetil “add-on” treatment in congestive heart failure outpatients in daily practice

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Abstract

Aims

In the present study, we investigated the efficacy and safety of candesartan cilexetil (candesartan) as “add-on” treatment in congestive heart failure (CHF) in daily practice.

Methods and results

In this open-label, multicenter study 414 CHF outpatients (NYHA II/III) with left ventricular ejection fraction (LVEF) ≤ 40% and plasma brain natriuretic peptide (BNP) levels > 200 pg/ml at baseline were enrolled. Patients were treated with standard therapy including at least one angiotensin converting enzyme inhibitor in addition to another CHF drug; 91% of the patients received beta-blockers. Candesartan was uptitrated to 32 mg/day (target dose if tolerated) during 6 weeks followed by constant dosing over 16 weeks. The primary endpoint plasma BNP was significantly reduced by 25% at week 22 (from 394 to 295 pg/ml, P < 0.0001 vs. baseline). Candesartan produced early and sustained improvements of plasma BNP/NT-pro-BNP, LVEF, and quality of life (SF-36) compared to baseline. Of patients on beta-blockers, 37% improved towards NYHA II/I at week 22 (P < 0.0001) and 53.5% of the patients in NYHA III at baseline improved into NYHA II/I at week 22 (n = 232, P < 0.0001). Candesartan was well tolerated; no unexpected findings were reported besides known adverse reactions including hypotension, hyperkalemia, and serum creatinine elevations.

Conclusion

Candesartan “add-on” treatment provides a good benefit/risk ratio in CHF outpatients in daily practice, although high-risk patients should be managed with frequent monitoring of BP, serum potassium, and renal function.

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Acknowledgments

The authors would like to thank PD Dr. Förster, PD Dr. Winkelmann, Dr. Baar, Dr. Schreckenberg, Dr. Stenzel, Dr. Bott, Dr. Rüdell, Dr. Lange, Dr. Lang, Dr. Krämer, Dr. Altmann, Dr. Loskyll, Dr. Meisel, Dr. Jänsch, Dr. Haustein, Dr. Kokott, Dr. Bischoff, Dr. Weppner, Dr. Pres-Gurwitz, Dr. Taggeselle, Dr. Bluschke, Dr. Gärtner, Dr. Möller, Dr. Younossi, Dr. Ewert, Dr. Wagner, Dr. Henke, Dr. Windstetter, Dr. Jeserich, Dr. Diekmann, Dr. Hohensee, Dr. Tammen, Dr. Hahn, Dr. Duda, Dr. Rummel, Dr. Braun, Dr. Gramann, Dr. Gabelmann, Dr. Sotiriou, Dr. Türk, Dr. Böhmeke, Dr. Camerer, Dr. Schröder, Dr. Stahl, Dr. Meyer, Dr. Büscher, Dr. Beermann, Dr. Staubach, Dr. Kleinertz, Dr. Nordbeck, Dr. Schmidt-Rauch, Dr. Noeske, Dr. Mollenhauer, Dr. Albrecht, Dr. Lorenz, Dr. Häge, Dr. Jochum, Dr. Rodemerk, Dr. Blum and Dr. Reynen for their continuous commitment as regards patient recruitment and care.

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Authors and Affiliations

  1. Department of Cardiology, Kerckhoff-Klinik GmbH, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

    Veselin Mitrovic & Christian Wilhelm Hamm

  2. Ambulantes Herzzentrum, Bergmannstraße 28, 34121, Kassel, Germany

    Karl-Friedrich Appel

  3. Kardiologische Gemeinschaftspraxis, Ziegelkampstraße 37, 31582, Nienburg, Germany

    Nicolaos Proskynitopoulos

  4. Kardiologische Gemeinschaftspraxis, Wilhelmshöher Allee 91, 34121, Kassel, Germany

    Seyfettin Dereli

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  1. Veselin Mitrovic
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Correspondence to Veselin Mitrovic.

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Mitrovic, V., Appel, KF., Proskynitopoulos, N. et al. Effects of candesartan cilexetil “add-on” treatment in congestive heart failure outpatients in daily practice. Clin Res Cardiol 98, 379–389 (2009). https://doi.org/10.1007/s00392-009-0011-7

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