title: Clinical outcomes according to baseline blood pressure in patients with a low ejection fraction in the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) Program.
abstract: OBJECTIVE
  This study sought to investigate the efficacy and tolerability of candesartan, according to baseline blood pressure (BP), in the 4,576 patients with a low ejection fraction (EF) (<or=0.40) in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) program.
  
  
  BACKGROUND
  Hypotension is a predictor of poor prognosis in heart failure, yet many treatments shown to reduce morbidity and mortality lower blood pressure. This paradox creates a dilemma for physicians and may explain why low BP is reported as a reason for under-use of these agents.
  
  
  METHODS
  The interaction between treatment and baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) was examined with patients divided into 6 SBP categories (<or=100, 101 to 110, 111 to 120, 121 to 130, 131 to 140 and >or=141 mm Hg) and 4 DBP categories (<or=60, 61 to 70, 71 to 80 and >or=81 mm Hg).
  
  
  RESULTS
  Low SBP and DBP were associated with worse clinical outcomes. Baseline BP did not modify the effects of candesartan on clinical outcomes: the interaction p value between SBP category and treatment was 0.38 (0.22 for DBP category). For both placebo and candesartan, study drug discontinuation for adverse effects (especially hypotension) was highest in patients in the lowest baseline BP categories. However, the relative risk of discontinuation for hypotension, renal dysfunction, and hyperkalemia in the candesartan compared with placebo group was not increased in patients with a low baseline BP.
  
  
  CONCLUSIONS
  In patients with low EF heart failure, the relative risks and benefits of candesartan treatment were similar in patients with a low BP compared to those with a higher BP.
authors.affiliation: Faculty of Medicine, University of Glasgow, Glasgow, Scotland.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Meredith
authors.forename: Jan
authors.initials: J
authors.lastname: Ostergren
authors.forename: Inder
authors.initials: I
authors.lastname: Anand
authors.forename: Margareta
authors.initials: M
authors.lastname: Puu
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Eric L
authors.initials: EL
authors.lastname: Michelson
authors.forename: Bertil
authors.initials: B
authors.lastname: Olofsson
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects*; D003971:Diastole; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole; D013777:Tetrazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan