In one of the largest recent studies on heart failure, doctors have found that adding the blood pressure drug Atacand to a patient’s drug regimen can significantly reduce hospital admissions and cardiovascular death."It’s a study that really clarifies for the first time many very important questions about angiotensin receptor blockers (ARB’s) in heart failure," said Dr. James Young, Vice Chairman of the Department of Cardiovascular Medicine and Medical Director of the Kaufman Center for Heart Failure, Cleveland Clinic Foundation.
"It clearly shows, in the broad spectrum of heart failure, a reduction in morbidity and mortality…when the ARB candesartan (Atacand) is added on top of aggressive medical therapies," said Young.
The results of the trial were presented at the Heart Failure Society of America’s Annual Meeting at the end of September. Astra Zeneca, which makes Atacand, funded the trial.
It involved more than 7,600 patients with classic symptoms of heart failure. The study was broken down into 3 different trials depending on the patients’ conditions.
The first included patients with a severely weakened left side of the heart—the main pumping chamber—in which their ejection fraction was less than 40 percent. This is a measurement that cardiologists use to tell how well the heart is pumping, with 100 percent being perfect. All of these patients were on standard heart failure therapy, which included a beta-blocker and an ACE inhibitor, but half were also put on Atacand. After two years the patients on Atacand had 15 percent fewer deaths or visits to the hospital for heart failure.
The second trial included patients who also had an ejection fraction of less than 40 percent and were on standard heart failure therapy. However, all of these patients had become intolerant of ACE inhibitors, so half of the participants were put on Atacand as an alternative to the ACE inhibitor. In these patients Atacand reduced the incidence of death and hospitalization by 23 percent.
Finally, the third trial included patients whose heart failure was less severe and had an ejection fraction of greater than 40 percent. Half were put on Atacand and the rest were given a placebo. After two years this group also saw a reduction in hospital admissions, but the death rate was unaffected.
Dr. Young said the results show that there’s added value to putting patients on Atacand even if they’re already taking an ACE inhibitor and a beta-blocker.
"This gives clinicians new options to even further drive down the morbidity and mortality of heart failure," said Young.
Nearly 5 million Americans are living with chronic heart failure according to the American Heart Association, and more than 500,000 new cases are diagnosed each year. It occurs when the heart can no longer pump enough blood to the rest of the body, resulting in congestion in the lungs and limbs and severe fatigue. The condition is usually brought on by coronary artery disease, heart attacks, congenital heart disease, severe lung disease, or hypertension.
Angiotensin receptor blockers, such as Atacand, are prescribed for patients with high blood pressure, usually as second-line therapy in those who can no longer tolerate or benefit from an ACE inhibitor. Atacand inhibits a substance called angiotensin, which causes the blood vessels to constrict contributing to hypertension.
"It’s not an inexpensive drug by any means, it’s not a terribly expensive drug either," said Dr. Young, "and if you look at the risk of cardiovascular death and the risk of heart failure hospitalizations being rather substantially reduced—yes—it’s a very cost-effective drug."
