- Question
- Can an angiotensin-receptor blocker (candesartan) reduce mortality and morbidity in patients with chronic heart failure?
- Design
- Programme of three parallel, randomised, double-blind, placebo-controlled trials analysed by intention to treat. A total of 7601 patients were randomised (7599 with data), with a median follow-up of 37.7 months.
- Population
- Patients with chronic heart failure in three populations: LVEF 40% or less not receiving ACE inhibitors because of previous intolerance, LVEF 40% or less currently receiving ACE inhibitors, and LVEF higher than 40%.
- Intervention
- Candesartan, titrated to 32 mg once daily.
- Control
- Matching placebo.
- Primary outcome
- For the overall programme, all-cause mortality; for each component trial, cardiovascular death or hospital admission for heart failure.
- Results
- Death occurred in 886 patients (23%) on candesartan and 945 (25%) on placebo (unadjusted HR 0.91; 95% CI 0.83-1.00; p=0.055; covariate-adjusted HR 0.90; 95% CI 0.82-0.99; p=0.032). Candesartan led to fewer cardiovascular deaths (691 [18%] vs 769 [20%]; unadjusted HR 0.88; 95% CI 0.79-0.97; p=0.012) and fewer hospital admissions for heart failure (757 [20%] vs 918 [24%]; p<0.0001).
- Safety
- More patients discontinued candesartan than placebo because of concerns about renal function, hypotension and hyperkalaemia.
- Conclusion
- Candesartan was generally well tolerated and significantly reduced cardiovascular deaths and heart failure hospitalisations, with effects unaltered by ejection fraction or baseline treatment.
- Why it matters
- It showed that an angiotensin-receptor blocker provides benefit in chronic heart failure across a broad range of patients, including those intolerant of ACE inhibitors and those with preserved ejection fraction, widening therapeutic options.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026