Reem Mustafa, MD, MPH; Amit X. Garg, MD, PhD
In hemodialysis patients with chronic heart failure (CHF) and impaired left ventricular ejection fraction (LVEF), does adding telmisartan to standard therapies reduce mortality and morbidity?
Randomized placebo-controlled trial. ClinicalTrials.gov NCT00490958.
Blinded (patients and clinicians).*
Mean 35.5 months.
30 clinics of a dialysis provider network in Italy.
332 adults (mean age 63 y, 54% men) who were receiving hemodialysis and had CHF (New York Heart Association functional class II or III), had LVEF ≤ 40% within 6 months, and were receiving individually optimized and unchanged angiotensin-converting enzyme (ACE) inhibitors for ≥ 30 days before randomization.
Telmisartan, titrated to a target dose of 80 mg/d (n = 165), or placebo (n = 167).
Primary outcomes were all-cause mortality, cardiovascular death, and hospitalization for worsening CHF. Secondary outcomes included acute nonfatal myocardial infarction (MI) and nonfatal stroke.
86% (intention-to-treat analysis).
Patients in the telmisartan group had lower rates of all-cause mortality, cardiovascular death, and hospitalization for CHF than did the placebo group; groups did not differ for nonfatal MI or stroke (Table).
In hemodialysis patients with chronic heart failure (CHF) and impaired left-ventricular ejection fraction, adding telmisartan to standard therapy with angiotensin-converting enzyme inhibitors reduced all-cause and cardiovascular mortality and hospitalizations for CHF.
Telmisartin vs placebo added to ACE inhibitors in hemodialysis patients with chronic heart failure (CHF) and impaired LVEF†
†ACE = angiotensin-converting enzyme; LVEF = left ventricular ejection fraction; other abbreviations defined in Glossary. RRR, NNT, and CI calculated from control event rates and hazard ratios reported in article, which were adjusted for clinical, echocardiographic, and laboratory variables.
Mustafa R, Garg AX. In hemodialysis patients with CHF, adding telmisartan to standard ACE inhibitors reduced CHD mortality and admissions. Ann Intern Med. ;154:JC5–5. doi: 10.7326/0003-4819-154-10-201105170-02005
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Published: Ann Intern Med. 2011;154(10):JC5-5.
Cardiology, Coronary Risk Factors, Heart Failure, Hypertension, Nephrology.
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