title: Effects of combined candesartan and ACE inhibitors on BNP, markers of inflammation and oxidative stress, and glucose regulation in patients with symptomatic heart failure.
abstract: BACKGROUND
  We assessed the effects of candesartan in addition to angiotensin-converting enzyme (ACE) inhibitors on N-terminal pro-type natriuretic peptide (Nt-proBNP), systemic markers of inflammation and oxidative stress as well as on glucose regulation in patients with heart failure (HF).
  
  
  RESULTS
  Eighty patients with HF ages 62.5 +/- 8.4 years presenting mostly with New York Heart Association class II symptoms (class II = 57.5%, III = 41.3%), and mean left ventricular ejection fraction 27.1 +/- 7.3% were recruited. The patients were randomized to receive candesartan titrated to 32 mg 1 per day versus placebo in double-blind fashion for 6 months. Nt-proBNP, markers of inflammation and oxidative stress, glucose, insulin, and fasting insulin resistance index were analyzed. Candesartan decreased Nt-proBNP (median value = 12.4% versus -20.4%; [candesartan] P = .05), and high-sensitivity C-reactive protein (hsCRP) (+5.32% versus -20.3% [candesartan]; P = 0.046), without significantly influencing serum interleukin-6, interleukin-18, adhesion molecules, or markers of oxidative stress. Blood glucose decreased in patients treated with candesartan with a significantly greater effect in patients with higher blood glucose levels (P < .01 for interaction).
  
  
  CONCLUSIONS
  The addition of candesartan to ACE inhibitor and beta-blocker decreases Nt-proBNP and hsCRP, but does not change the other markers of inflammation or oxidative stress in patients with heart failure. Dual angiotensin-II suppression also decreased blood glucose with a greater impact in patients with higher blood glucose level.
authors: Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors: Michel
authors: M
authors: White
authors: Serge
authors: S
authors: Lepage
authors: Joel
authors: J
authors: Lavoie
authors: Simon
authors: S
authors: De Denus
authors: Marie-Hélène
authors: MH
authors: Leblanc
authors: Denis
authors: D
authors: Gossard
authors: Lucette
authors: L
authors: Whittom
authors: Normand
authors: N
authors: Racine
authors: Anique
authors: A
authors: Ducharme
authors: Farida
authors: F
authors: Dabouz
authors: Jean-Lucien
authors: JL
authors: Rouleau
authors: Rhian
authors: R
authors: Touyz
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001713:Biphenyl Compounds; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D001794:Blood Pressure / Q000187:drug effects; D003124:Colorimetry; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000187:drug effects; D018384:Oxidative Stress / Q000187:drug effects*; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000187:drug effects; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D015415:Biomarkers; D001713:Biphenyl Compounds; D001786:Blood Glucose; D007328:Insulin; D013777:Tetrazoles; D020097:Natriuretic Peptide, Brain; D003404:Creatinine; C081643:candesartan