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Candesartan Investigated in Hypotensive Patients

Close monitoring for adverse effects should govern any evidence-based approach

TUESDAY, Dec. 2 (HealthDay News) -- Among heart failure patients with low ejection fraction and low systolic blood pressure, treatment with candesartan is still efficacious, according to the results of a clinical study reported in the Dec. 9 issue of the Journal of the American College of Cardiology.

In a retrospective analysis of two low ejection fraction (not exceeding 0.40) trials comprising 4,576 patients in the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) program, Peter A. Meredith, Ph.D., of the University of Glasgow in Scotland, and colleagues investigated the efficacy and tolerability of candesartan, according to baseline blood pressure. The primary outcomes were cardiovascular death or heart failure hospitalization, and all-cause mortality.

The findings indicate that the risk of cardiovascular death or heart failure hospitalization increased with systolic blood pressure under 110 to 100 mm Hg. However, treatment with candesartan did not modify the outcome with different systolic blood pressure categories or diastolic blood pressure categories. Even the increased all-cause mortality did not influence treatment outcome with candesartan. Indeed, despite adverse effects of hypotension, renal dysfunction and hyperkalemia, a majority of patients obtained therapeutic benefits.

"A low systolic blood pressure should not deter physicians from prescribing evidence-based therapy with a hypotensive action, although such treatment should, of course, be used cautiously and with appropriate monitoring of patients for tissue underperfusion, for example, causing pre-syncope/syncope or worsening renal function," the authors conclude.

The study authors have disclosed financial relationships with pharmaceutical companies.

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