Effects Of The Little Dosage Angiotensin Ⅱ Antagonist, Candesartan Cilexetil, On Patients With Congestive Heart Failure In Short Time

CHF is one of the common and frequently encountered diseases doing great harm to human health. Because of its high mutilation rate and poor prognosis, it has become the main cause of the death and workless among patients with cardiovascular diseases. It has been established that the mortality of the patients with CHF in 5 years is as high as 50-60%, while the mortality of the patients with cardiac function IV (NYHA degree) in 1 year is 50%. Recently more and more doctors have recognized that CHF is a progressing course but not still. The pathophysiology of CHF is very complicated. With the in-depth study of the pathophysiologic mechanism of CHF, the strategy to deal with CHF has been radically changed from short-term haemodynamic and pharmacological way to long-term repairing one. In the past, we used drugs mainly to strengthen the myocardial contractility, but now biological way improving neurohormonal dysfunction and preventing the remodelling of the ventricle, has become the main treatment. The aim is to improve symptoms, quality of life, prevent and delay the development of CHF, to decrease mortality and hospital admission rate. Now, we mainly use diuretic agent, RAAS blocker, beta-receptor blocker, with digitalis as subsidiary use. Following this notion, angiotensin-converting enzyme inhibitor has been the milestone in the treatment of CHF. Because of its adverse effects, especially dry cough, which is frequently seen in clinical work, many patients don't tolerate this kind of drug. Angiotensin II receptor blocker (ARB) is used as the alternative of ACEI for the patient's intolerate of ACEI. Candesartan was a newly approved drug to treat CHF,reducing mortality and hospital admission rate according to the research result of Candesartan in Heart Failure-Association of Reduction in Mortality (CHARM).Objective By measuring left ventricular ejection fraction, left ventricular end-diastolic diameter, serum potassium and serum creatinine, we study the therapeutic effects of small dose, short-term use of angiotensin II antagonist-candesartan cilexetil on patients with congestive heart failure in this paper.Methods 61 patients with function class II-IV and LVEF<40% were randomly divided into Candesartan Cilexetil Tablets group and conventional group. Clinical symptoms were observed. Heart function, serum potassium and creatinine were performed in pre-treatment and post-treatment. Result Compared post-treatment with pre-treatment or between two groups, there were all significant differences in LVEF (p<0.01). The LVEF of Candesartan Cilexetil Tablet group and conventional group rised from 30.80±7.76% to 41.97±7.86% and from 31.07±8.26% to 36.40±8.33%, respectively. The change of LVEDD was not obvious in both groups (p>0.05). Serum potassium was increased from 4.06±0.52 (mmol/l)to 4.29±0.48mmol/l in Candesartan Cilexetil Tablet group(p<0.01)and from 4.10±0.51mmol/l to 4.35±0.47mmol/l in conventional group(p < 0.01). But there was no difference between two groups(P>0.05). There were no differences in serum creatinine(P>0.05).The patients in the Candesartan Cilexetil Tablets group were divided further into 4mg group (n=21) and 8mg group (n=9) according to the daily oralintake quantity. There were significant differences in LVEF before and after the treatment. LVEF changed from 29.62±8.31(%) to 41.48±8.40(%) in 4mg group (p<0.01), while it changed from 33.56±5.80(%)to 43.11±6.74(%)in 8mg group(P < 0.01),but no significant difference between groups(P>0.05). Serum potassium changed from 4.00±0.48(mmol/l) to 4.24±0.44(mmol/l) in the 4mg group (p <0.01)and from 4.19±0.62 (mmol/l) to 4.41±0.56(mmol/l)in 8mg group(P<0.01) but no difference between groups(P>0.05). There were no difference in LVEDD and serum creatinine in 4mg group or 8mg group(P>0.05).Conclusion First, Short-term and small dosage of Candesartan Cilexetil Tablet greatly improves the LVEF, clinical symptoms on the basis of regular treatment using ACEI . Second, Change of LVEDD is not obvious, indicating that the ventricular remodelling needs to be treated for a long time to get improvement.Third, The combination of candesartan and regular drugs will not increase the incidence of adverse effects. But patients with hyperkalemia or kidney function impairment should be monitored serum ion and kidney function during treatment. Fourth, There is no difference in LVEF,LVEDD,serum potassium and serum creatinine between 4mg and 8mg groups of short-term and small dose administration of candesartan. So it is recommended that for patients who receive short-term treatment, the least quantity -4mg of candesartan cilexetil tablet is just enough to reach the goals of treatment.