ARCTIC: Assessment of haemodynamic response in patients with congestive heart failure to telmisartan: A multicentre dose-ranging study in Canada

Background The aim of this study was to examine the acute hemodynamic and n eurohormonal effects of the angiotensin II antagonist telmisartan relative to placebo in patients with chronic symptomatic (New York Heart Association class II to III) congestive heart failure and to explore the dose-response relation for these effects. Methods and Results After baseline hemodynamic and neurohormonal measuremen ts made with the use of a pulmonary artery and radial arterial catheter, 82 patients were randomly assigned to placebo or 10, 20, 40, or 80 mg of telm isartan in a double-blind fashion. Hemodynamic and neurohormonal measuremen ts were carried out over 24 hours. Telmisartan caused significant decreases in systemic arterial, pulmonary arterial, and pulmonary capillary wedge pr essures with evidence of a dose-response relation for each of these paramet ers. The drug had no significant effects on heart rate, cardiac index, or s ystemic vascular resistance. Telmisartan did not have consistent effects on either plasma norepinephrine or plasma atrial natriuretic peptide levels, although it did cause significant increases in both plasma renin activity a nd angiotensin II levels at higher doses. Conclusions The acute administration of the angiotensin II antagonist telmi sartan was associated with significant dose-dependent reductions in systemi c arterial blood pressure and pulmonary pressures. Long-term follow-up stud ies are required to translate changes in hemodynamic parameters into a clin ical benefit.