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In patients with chronic heart failure, angiotensin-receptor blockers (ARBs) have shown promise for enhancing the benefit of ACE inhibitors and as an alternative to ACE inhibitors when patients cannot tolerate them. In the manufacturer-sponsored, double-blind CHARM trial, symptomatic heart-failure patients were randomized to the ARB candesartan (target dose, 32 mg once daily) or placebo.
The randomization protocol was used in 3 separate trial arms, each featuring a different category of patients: 2548 with LV ejection fractions of ≤40% who already were taking ACE inhibitors; 2028 with LVEFs of ≤40% who could not tolerate ACE inhibitors; and 3023 with LVEFs >40% (19% were taking ACE inhibitors). The primary endpoint of the entire trial was al…