title: Addition of candesartan to angiotensin converting enzyme inhibitor therapy in patients with chronic heart failure does not reduce levels of oxidative stress.
abstract: BACKGROUND
  Angiotensin II exerts a number of harmful effects in patients with chronic heart failure (CHF) and, through an increase in oxidative stress, is thought to be critical in the development of endothelial dysfunction. Angiotensin II may be elevated in CHF despite treatment with angiotensin converting enzyme (ACE) inhibitors, producing a rationale for adjunctive angiotensin receptor blockade. We investigated whether the addition of angiotensin antagonism to ACE inhibition would reduce oxidative stress and improve endothelial function and exercise tolerance in patients with chronic heart failure.
  
  
  RESULTS
  Twenty-eight heart failure patients, who were on stable ACE inhibitor therapy, were randomised to receive adjunctive therapy with candesartan or placebo. Plasma lipid-derived free radicals, TBARS and neutrophil O2-generation, markers of oxidative stress, were measured in venous blood. Arterial endothelial function was assessed as the response of the brachial artery to flow-related shear stress. Exercise capacity was determined by cardiopulmonary exercise testing. Compared with placebo, candesartan had no effect on changes in lipid derived free radicals (-0.1+/-1.2 vs. -0.1+/-1.0 units, respectively, P=NS), TBARS (-2.2+/-1.1 vs. -2.6+/-2.2 micromol/l, respectively, P=NS) or neutrophil O2-generating capacity (-7.3+/-5.1 vs. -8.4+/-7.9 mV/5x10(5) neutrophils, respectively, P=NS). There was no effect on changes in brachial artery flow-mediated dilatation (0.5+/-1.0 vs. 0.8+/-1.3%, respectively, P=NS) nor peak VO2 (1.6+/-0.7 ml/kg per min vs. 1.8+/-0.6 ml/kg per min; P=NS).
  
  
  CONCLUSIONS
  The addition of the candesartan to ACE inhibitor therapy had no effect on oxidative stress and did not improve endothelial function or exercise capacity in patients with CHF.
authors.affiliation: Department of Cardiology, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, UK. gethin.ellis@pr-tr.nhs.wales.uk
authors.forename: Gethin R
authors.initials: GR
authors.lastname: Ellis
authors.forename: Angus K
authors.initials: AK
authors.lastname: Nightingale
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Anderson
authors.forename: Catherine
authors.initials: C
authors.lastname: Mumford
authors.forename: Graham
authors.initials: G
authors.lastname: Timmins
authors.forename: Derek
authors.initials: D
authors.lastname: Lang
authors.forename: Simon K
authors.initials: SK
authors.lastname: Jackson
authors.forename: Michael D
authors.initials: MD
authors.lastname: Penney
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Lewis
authors.forename: Michael P
authors.initials: MP
authors.lastname: Frenneaux
authors.forename: Jayne
authors.initials: J
authors.lastname: Morris-Thurgood
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects; D001916:Brachial Artery / Q000737:chemistry; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D004730:Endothelium, Vascular / Q000187:drug effects; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D015227:Lipid Peroxidation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects; D018384:Oxidative Stress / Q000187:drug effects*; D013318:Stroke Volume / Q000187:drug effects; D013777:Tetrazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; D020097:Natriuretic Peptide, Brain; C081643:candesartan