Candesartan decreases brain natriuretic peptide, tumor necrosis factor-α, interleukin-6 and C- reactive protein levels, reduces cardiac hypertrophy and improves ejection fraction in diabetic patients with congestive heart failure

Brain natriuretic peptide (BNP) level is increased in congestive heart failure (CHF). Tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C- reactive protein (CRP) contributes to the pathogenesis of left ventricular hypertrophy (LVH) and CHF. Diabetic patients have increased cytokines and CHF. ACE inhibitors are the standard drugs for diabetic patients with CHF, but angiotensin receptor blockers (ARB) have fewer side effects. Therefore, the American Diabetes Association (ADA) places ARB as the first-line drug for type 2 diabetic patients with hypertension. Candesartan (C) is a long acting ARB. To study the effects of C on BNP, cytokines, and CHF, we administered 32 mg C to 12 diabetic patients with CHF (EF < 30%), and measured the BNP, TNF-alpha, IL-6, CRP, Angiotensin II (All) levels, and performed echocardiograms to assess the EF and LVH q2mo. Basal BNP were elevated. BNP dropped inversely to All rise, and then BNP rose and remained just above the upper limit of normal. TNF-alpha, IL-6 & CRP were elevated, and decreased by C. LVH decreased and EF increased significantly after 6 months. Thus, candesartan can be an effective treatment for CHF in diabetic patients who cannot tolerate ACE inhibitor.