Cardiovascular Drugs and Therapy

, Volume 26, Issue 2, pp 131–143 | Cite as

Effects of Candesartan on Left Ventricular Function, Aldosterone and BNP in Chronic Heart Failure

  • Aneta Aleksova
  • Serge Masson
  • Aldo P. Maggioni
  • Donata Lucci
  • Renato Urso
  • Lidia Staszewsky
  • Stefano Ciaffoni
  • Giuseppe Cacciatore
  • Gianfranco Misuraca
  • Michele Gulizia
  • Lucio Mos
  • Gianni Proietti
  • Calogero Minneci
  • Roberto Latini
  • Gianfranco Sinagra
  • on the behalf of the CandHeart Investigators



Heart failure (HF) is characterized by activation of neurohormonal systems such as aldosterone and natriuretic peptides. In the absence of published data, CandHeart trial was designed to assess the effects on left ventricular (LV) function, aldosterone and brain natriuretic peptide (BNP) of candesartan in patients with HF and preserved (LVEF ≥ 40%) or depressed (LVEF <40%) LV systolic function.


A total of 514 patients with stable symptomatic NYHA II-IV HF and any left ventricular ejection fraction (LVEF)were randomized to candesartan (target dose 32 mg once daily) as add-on therapy or standard medical therapy alone. Standardized echocardiographic exams were performed locally under central quality control, whereas biomarkers were assayed in a core laboratory.


The majority of patients (73.3%) were NYHA II and on ACE inhibitors (91.8%) and beta-blockers (85.4%). Mean age was 66 ± 11 years. Mean LVEF was 36.2 ± 9.7% and 24.9% of patients had LVEF ≥ 40%. LVEF increased significantly more in the candesartan group (p = 0.09 at 12 weeks and p = 0.01 at 48 weeks) and left ventricular end-diastolic diameter decreased in candesartan group (p = 0.05 at 12 weeks). Candesartan significantly reduced aldosterone at 48 weeks (p = 0.009). BNP was reduced similarly over time in both study groups (p = 0.35 and p = 0.98 at 12 and 48 weeks, respectively). There were 6.6% of discontinuations of candesartan for adverse events.


In CandHeart, the addition of candesartan to standard medical treatment did not reduce circulating BNP more than standard therapy (primary endpoint), but it significantly improved LV function and produced a marked decrease in aldosterone levels at study end.

Key words

Heart failure Aldosterone Natriuretic peptide Left ventricular ejection fraction Candesartan 



The authors are grateful to Alessandra Fionda and Daniela Angeletti, Takeda Italia Farmaceutici, for their continuous and enthusiastic support to the trial. We thank Giancarlo Giudici and Massimo Grigolon from Biosite Italy for analytical support.

Funding sources and disclosures

The CandHeart trial was supported by a grant from Takeda Italia Farmaceutici, Italy. Drs. Maggioni and Latini have received institutional research support


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Aneta Aleksova
    • 1
  • Serge Masson
    • 2
  • Aldo P. Maggioni
    • 3
  • Donata Lucci
    • 3
  • Renato Urso
    • 3
    • 4
  • Lidia Staszewsky
    • 2
  • Stefano Ciaffoni
    • 5
  • Giuseppe Cacciatore
    • 6
  • Gianfranco Misuraca
    • 7
  • Michele Gulizia
    • 8
  • Lucio Mos
    • 9
  • Gianni Proietti
    • 10
  • Calogero Minneci
    • 11
  • Roberto Latini
    • 2
  • Gianfranco Sinagra
    • 1
  • on the behalf of the CandHeart Investigators
  1. 1.Cardiovascular Department“Ospedali Riuniti” and University of TriesteTriesteItaly
  2. 2.Department of Cardiovascular ResearchIstituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
  3. 3.ANMCO Research CenterFlorenceItaly
  4. 4.Department of Neurological and Behavioral ScienceUniversity of Siena, Pharmacology SectionSienaItaly
  5. 5.Laboratory of Clinical Chemistry, Ospedale Sacro Cuore Don CalabriaNegrarItaly
  6. 6.Department of Cardiovascular Diseases, San Giovanni-Addolorata HospitalRomeItaly
  7. 7.Division of Cardiology, Ospedale Santissima AnnunziataCosenzaItaly
  8. 8.Cardiology Unit, Ospedale Garibaldi-NesimaCataniaItaly
  9. 9.Cardiology Unit, Ospedale Sant’AntonioSan Daniele del FriuliItaly
  10. 10.Cardiology Unit, Azienda ASL 4TerniItaly
  11. 11.Cardiology Unit, Ospedale San Giovanni di DioFlorenceItaly

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