Clinical Question: Does candesartan effectively reduce mortality and prevent hospitalizations in patients with congestive heart failure (CHF) who have an ejection fraction greater than 40 percent?

Setting: Outpatient (any)

Study Design: Randomized controlled trial (double-blinded)

Synopsis: In this part of the Cardiovascular Health and Risk Measurement trio of studies, patients with New York Heart Association class II or worse CHF with an ejection fraction greater than 40 percent were randomly assigned (masked allocation) to receive treatment with candesartan (n =1,514) or placebo (n = 1,509). The initial dosage, chosen by the study physician, was 4 mg or 8 mg of candesartan once daily or matching placebo. The dosage was doubled every two weeks to a target dosage of 32 mg once daily, if tolerated. Once the patients reached their target dosage, the investigators followed up every four months. The outcomes were assessed by intention-to-treat. Cardiovascular mortality and noncardiovascular mortality were the same in both groups, as was hospitalization for any cause. The study was powered to detect an 18 percent relative reduction in outcomes.

Bottom Line: In patients with CHF who have preserved left-ventricular function, candesartan has no meaningful effect on all-cause mortality or hospitalizations for any reason. (Level of Evidence: 1b)