Use of ARB in Patients Intolerant of an ACE Inhibitor

To the Editor:

I would like to know Dr. Aronow’s¹ choice of angiotensin receptor blocker in patients intolerant of angiotensin-converting enzyme (ACE) inhibitor therapy, and why.

Thank you,

(Dr.) Frank M. Shanley, PA, FACC, FCCP
Denville, NJ

Reference

1. Aronow WS. Q & A with the expert on: Congestive heart failure. Annals of Long-Term Care: Clinical Care and Aging 2009;17(9):19-20.

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Response from Dr. Aronow:

On the basis of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity--Alternative Study,¹ I prefer candesartan. In this study, 2028 patients with heart failure, an abnormal left ventricular ejection fraction, and intolerance to ACE inhibitors were randomized to candesartan 32 mg once daily or to double-blind placebo. At 34-month median follow-up, candesartan significantly reduced the incidence of cardiovascular death or hospitalization for heart failure by 30%.

Wilbert S. Aronow, MD, FACC, FAHA, AGSF
Clinical Professor of Medicine New York Medical College
Valhalla, NY

Reference

1. Granger CB, McMurray JJV, Yusuf S, et al, for the CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: The CHARM-Alternative trial. Lancet 2003;362:772-776.