CHARM Program: 3 Component trials comparing candesartan with placebo.

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Presentation transcript:

CHARM Program: 3 Component trials comparing candesartan with placebo

CHARM Program: Baseline characteristics

CHARM Program: Baseline medications

CHARM-Overall: CV death and non-CV death

CHARM Program: Reduction in mortality and morbidity

CHARM Program: Reduction in CHF hospitalization

CHARM-Preserved: Hospital admissions for CHF

CHARM-Overall: Effects of candesartan on CV death or HF hospitalization—Subgroup analysis

CHARM-Overall: Effects of candesartan on CV death or HF hospitalization—Subgroup analysis (cont’d)

CHARM-Added: Effect of combined ACE inhibitor/  -blocker/AT1-receptor blocker

CHARM-Overall: Drug discontinuations for adverse events

CHARM: Clinical implications

CHARM-Overall: Reduction in new-onset diabetes

CHARM: Impact of treatment

HF with preserved LV systolic function in the elderly: Impact on survival

CHARM-Preserved: CV death or CHF hospitalization

CHARM-Preserved: Primary and secondary outcomes

CHARM-Preserved: Clinical implications

VALIANT: Design

VALIANT: Concomitant medications

VALIANT: Treatments show similar effect on outcome

VALIANT: Clinical implications

VALIANT: Effect of treatment on mortality—Subgroup analysis

RESOLVD: Comparative impact of ACE inhibitor, ARB, and  -blocker alone or combined on LVEF

Differences in dosing among ARB trials

Survival studies of  -blockade in HF

 -Blockers improve survival in diabetic patients with HF: A meta-analysis

MERIT-HF:  -Blockade improves survival in CHF

MERIT-HF:  -Blockade improves survival in post-MI patients with HF

MERIT-HF: Subgroup analysis in post-MI patients with HF (LVEF <25%)

SOLVD: Heart rate predicts progression of asymptomatic LV dysfunction

MERIT-HF: Effect of  -blockade on heart rate

MERIT-HF:  -Blockade decreases mortality and hospitalization independent of resting heart rate

CHRISTMAS: Design

CHRISTMAS: Trial profile

CHRISTMAS: Change in LVEF according to number of segments affected by myocardial hibernation

COMET: Trial profile

COMET: All-cause mortality

COMET: Heart rate at each visit

COMET: Blood pressure

 -Blocker HF trials: Mortality results

Mortality rates in perspective CIBIS-II, MERIT-HF, COMET

Immediate-release vs sustained release metoprolol: Significant pharmacokinetic differences

COMET: Clinical implications

Comparison of  -blocker effects in major HF trials

Not all  -blockers are the same