© 2006 European Society of Cardiology
Pulsatile hemodynamic effects of candesartan in patients with chronic heart failure: The CHARM Program
a Cardiovascular Engineering, Inc. 327 Fiske Street, Holliston, MA 01746, USA
b London Health Sciences Centre London, ON, Canada
c Louis Stokes VA Medical Center Cleveland, OH, USA
d Ralph H. Johnson V. A. Medical Center Charleston, SC, USA
e Duke University Medical Center Durham, NC, USA
f University of Pennsylvania Medical Center Philadelphia, PA, USA
g Brigham and Women's Hospital Boston, MA, USA
* Corresponding author. Present address: Cardiovascular Engineering, Inc., University Office Park, Building 2, 51 Sawyer Road, Suite 100, Waltham, MA 02453. Tel.: +1 781 788 4900; fax: +1 781 788 4901. E-mail address: GaryFMitchell{at}mindspring.com
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Abstract |
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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 vs. >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.
Key Words: Hemodynamics • Pulse pressure • Aorta • Vascular stiffness • Angiotensin receptor blocker • Candesartan
Received February 9, 2005; Revised May 27, 2005; Accepted July 13, 2005
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