title: Pulsatile hemodynamic effects of candesartan in patients with chronic heart failure: the CHARM Program.
abstract: BACKGROUND
  Abnormal large artery function and increased pulsatile load are exacerbated by excess angiotensin-II acting through the AT1 receptor and contribute to the pathogenesis and progression of chronic heart failure (CHF).
  
  
  OBJECTIVE
  To evaluate effects of the AT1 receptor blocker candesartan (N = 30) or placebo (N = 34) on pulsatile hemodynamics in participants with CHF in the CHARM program.
  
  
  RESULTS
  Noninvasive hemodynamics were assessed following 6 and 14 months of treatment and averaged. Using calibrated tonometry and aortic outflow Doppler, characteristic impedance was calculated as the ratio of the change in carotid pressure and aortic flow in early systole. Total arterial compliance was calculated by the diastolic area method. Brachial blood pressure, cardiac output and peripheral resistance did not differ between groups. Lower central pulse pressure in the candesartan group (57+/-20 vs. 67+/-17 mmHg, P = 0.043) was accompanied by lower characteristic impedance (200+/-78 vs. 240+/-74 dyne s/cm5, P = 0.039) and higher total arterial compliance (1.87+/-0.70 vs. 1.47+/-0.48 ml/mmHg, P = 0.008). Similar favorable differences were seen when analyses were stratified for ejection fraction (< or = 0.40 vs. >0.40) and baseline angiotensin converting enzyme inhibitor use.
  
  
  CONCLUSIONS
  Candesartan has a favorable effect on large artery function in patients with chronic heart failure.
authors.affiliation: Cardiovascular Engineering, Inc., 327 Fiske Street, Holliston, MA 01746, USA. GaryFMitchell@mindspring.com
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.forename: J Malcolm O
authors.initials: JM
authors.lastname: Arnold
authors.forename: Mark E
authors.initials: ME
authors.lastname: Dunlap
authors.forename: Terrence X
authors.initials: TX
authors.lastname: O'Brien
authors.forename: Gordon
authors.initials: G
authors.lastname: Marchiori
authors.forename: Elaine
authors.initials: E
authors.lastname: Warner
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Desai
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000494:pharmacology*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001011:Aorta / Q000187:drug effects / Q000502:physiology; D001562:Benzimidazoles / Q000008:administration & dosage / Q000494:pharmacology*; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects*; D002200:Capillary Resistance / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002908:Chronic Disease; D003187:Compliance / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D013777:Tetrazoles / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan