Review: Optimising the use of Angiotensin Receptor Blockers in the Management of Chronic Heart Failure

Abstract

The Candesartan in Heart Failure Assessment of Reduction in Mortality and morbidity (CHARM) trial programme provided clear evidence of the efficacy of candesartan in the management of chronic heart failure (CHF) associated with reduced left ventricular (LV) systolic function. The morbidity and mortality benefits of candesartan were consistent irrespective of age, sex, ethnic origin or baseline heart failure therapy. Extensive safety analyses of the CHARM data have demonstrated that candesartan was well tolerated by patients receiving an angiotensin-converting enzyme (ACE) inhibitor (even at maximal doses) and beta-blocker, and by patients previously intolerant to an ACE inhibitor. They also demonstrated a low incidence of adverse effects, characteristic of drugs that inhibit the renin-angiotensin-aldosterone system CHARM provides conclusive evidence confirming the role of candesartan in the management of CHF patients with LV systolic dysfunction.Treatment should be initiated early to ensure optimum outcome, starting at a low dose (4 mg once daily) and increasing to a target dose of 32 mg once daily. Routine monitoring of blood pressure and of serum creatinine and potassium is warranted.