CHARM Program: 3 Component trials comparing candesartan with placebo

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CHARM Program 3 Component trials comparing
candesartan with placebo
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CHARM Program Baseline characteristics
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CHARM Program Baseline medications
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CHARM-Overall CV death and non-CV death
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CHARM Program Reduction in mortality and
morbidity
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CHARM Program Reduction in CHF hospitalization
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CHARM-Preserved Hospital admissions for CHF
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CHARM-Overall Effects of candesartan on CV death
or HF hospitalizationSubgroup analysis
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CHARM-Overall Effects of candesartan on CV death
or HF hospitalizationSubgroup analysis (contd)
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CHARM-Added Effect of combined ACE
inhibitor/?-blocker/AT1-receptor blocker
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CHARM-Overall Drug discontinuations for adverse
events
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CHARM Clinical implications
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CHARM-Overall Reduction in new-onset diabetes
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CHARM Impact of treatment
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HF with preserved LV systolic function in the
elderly Impact on survival
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CHARM-Preserved CV death or CHF hospitalization
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CHARM-Preserved Primary and secondary outcomes
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CHARM-Preserved Clinical implications
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VALIANT Design
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VALIANT Concomitant medications
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VALIANT Treatments show similar effect on outcome
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VALIANT Clinical implications
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VALIANT Effect of treatment on
mortalitySubgroup analysis
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RESOLVD Comparative impact of ACE inhibitor,
ARB, and ?-blocker alone or combined on LVEF
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Differences in dosing among ARB trials
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Survival studies of ?-blockade in HF
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?-Blockers improve survival in diabetic patients
with HF A meta-analysis
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MERIT-HF ?-Blockade improves survival in CHF
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MERIT-HF ?-Blockade improves survival in post-MI
patients with HF
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MERIT-HF Subgroup analysis in post-MI patients
with HF (LVEF lt25)
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SOLVD Heart rate predicts progression of
asymptomatic LV dysfunction
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MERIT-HF Effect of ?-blockade on heart rate
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MERIT-HF ?-Blockade decreases mortality and
hospitalization independent of resting heart rate
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CHRISTMAS Design
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CHRISTMAS Trial profile
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CHRISTMAS Change in LVEF according to number of
segments affected by myocardial hibernation
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COMET Trial profile
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COMET All-cause mortality
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COMET Heart rate at each visit
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COMET Blood pressure
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?-Blocker HF trials Mortality results
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Mortality rates in perspective CIBIS-II,
MERIT-HF, COMET
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Immediate-release vs sustained release
metoprolol Significant pharmacokinetic
differences
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COMET Clinical implications
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Comparison of ?-blocker effects in major HF trials
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Not all ?-blockers are the same