Blood Pressure Drug Helps Fight Heart Failure

It cuts death and hospitalization rates, study says

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HealthDay Reporter

MONDAY, Oct. 18, 2004 (HealthDayNews) -- Adding a blood pressure drug to the standard medications used to treat heart failure produces a small but significant decrease in deaths, researchers report.

The drug is candesartan (Atacand), a member of a family of medications called angiotensin II blockers that act against an enzyme that constricts blood vessels. Candesartan and its relatives usually are prescribed only to help control blood pressure. But the drug's manufacturer, AstraZeneca, sponsored a major trial designed to show its value against heart failure, a major cardiovascular killer.

An estimated 4.8 million Americans suffer from heart failure, the steady decline in the ability of the heart to pump blood, with 400,000 new cases diagnosed every year. It can be a deadly condition, with up to one of every five patients dying in the year after diagnosis. It is treated with a number of drugs, including ACE inhibitors and beta blockers.

The company-sponsored trial added candesartan to the drug regimen of 2,289 people treated for heart failure at 618 sites in 26 countries, comparing their outcomes with those of 2,287 patients who got the standard treatment. All had low ejection fractions, meaning that their hearts had a markedly reduced ability to pump blood.

After an average follow-up of 40 months, 31 percent of those getting the standard regimen had died, while the death rate for those who also got candesartan was 28 percent.

"When you stack that up against the other things we do in medicine, that was a significant impact," said study author Dr. James B. Young, medical director of the Cleveland Clinic Foundation Kaufman Center for Heart Failure.

Just as significant, Young said, was a reduction in the number of people who had to be hospitalized -- 28.1 percent for those getting standard treatment, compared to 22.5 percent for those also taking candesartan.

"After just a few months, there was a significant benefit," Young said.

The findings appear in the Oct. 19 issue of Circulation.

Because results of the trial are just being published, "candesartan is not being used widely now" to treat heart failure, Young said. "Publication of this data will draw attention to the fact that we have another option out there. It is going to add a lot of information to clinicians for patients who have low ejection fractions."

Dr. Ann Bolger is associate professor of medicine at the University of California, San Francisco, and a spokeswoman for the American Heart Association. She said, "It is always incredibly helpful to have another tool that has been proven to have both safety and effectiveness." But, she added, some questions about the study still have to be answered.

One is whether other angiotensin II blockers would have the same effect in heart failure patients. Candesartan is the only member of the family to be tested against the condition, Young said.

Another issue is whether candesartan should be used strictly as an add-on medication or could be prescribed earlier, Bolger said.

"This study does not address how you develop strategy for its use," she said. "As of now, I would treat it as an add-on drug, not as an initial medication."

More information

The American Heart Association has more on heart failure and how to live with it.

SOURCES: James B. Young, medical director, Cleveland Clinic Foundation Kaufman Center for Heart Failure, Cleveland; Ann Bolger, M.D., associate professor, medicine, University of California, San Francisco; Oct. 19, 2004, Circulation

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