Telmisartan in CHF Haemodialysis Patients

2 Nov, 11

Addition of Telmisartan to ACE Inhibitors Decreases Mortality and Morbidity in Haemodialysis Patients with CHF and Low LVEF

Background

Congestive heart failure (CHF) is responsible for high mortality rate in end stage renal disease (ESRD) patients, yet very few data is available with regard to this population.

To evaluate whether telmisartan in addition to standard therapy of angiotensin-converting enzyme inhibitors (ACE-I) can decrease all-cause and cardiovascular morbidity and mortality in ESRD patients with comorbid CHF undergoing haemodialysis and with impaired left ventricular ejection fraction (LVEF).

Study Patients

ESRD with comorbid CHF (NYHA class II to III; LVEF ≤40%) undergoing haemodialysis (N=332).

Study Treatments

Patients continued standard ACE-I throughout the study period. Conventional heart failure treatments, including beta blocker carvedilol and digitalis were recommended when appropriate.

The patients were randomized into:

Telmisartan (n= 165) Starting with 20 mg/day the dose of study drug was doubled, as tolerated, every 2 weeks to target dose of 80mg/day.
Placebo (n=167)

Study Duration

3 years

Primary Endpoints

ll-cause mortality
Cardiovascular death
Hospital admission for management of worsening CHF

Results

Telmisartan significantly reduced all-cause mortality as compared to placebo

Significant reduction in cardiovascular mortality and CHF hospitalization occurred with telmisartan

Beneficial effects of telmisartan on all-cause mortality and CV mortality were evident within 6 months of treatment and persisted for the entire treatment period.
Beneficial effects were seen even in patients with beta-blockers and ACE inhibitors.
A significant reduction from baseline in both systolic (118.3 ± 7.2 mm Hg vs. 125.3 ± 7.3 mm Hg; p=0.006) and diastolic (78.2 6 ± 5.4 mm Hg vs. 83.7 ± 7.1 mm Hg; p=0.004) blood pressure was observed in the telmisartan group during the first year of treatment

Significant improvement was seen in clinical and echocardiographic endpoints with telmisartan

Conclusion

Telmisartan significantly reduces all-cause mortality, cardiovascular death and hospital admission for decompensated heart failure in haemodialysis patients with CHF and LVEF ≤ 40% when added to standard therapies including ACE-I and beta blockers.

J Am Coll Cardiol 2010; 56:1701-1708