1、N=14703,急性心肌梗死（0.5-10天），合并心力衰竭的临床/放射影像学证据和/或左室收缩功能障碍主要终点：全因死亡率次要终点：心血管死亡、心力衰竭住院、心肌梗塞复发平均随访时间：24.7月事件驱动卡托普利50mg tid（n=4909）缬沙坦 160mg Bid（n=4909）卡托普利50mg tid+缬沙坦 80mg Bid（n=4885）随机、双盲、活性药对照Months after randomizationMortality(%)0061218243036510152025All-cause mortalityDickstein et al.Lancet 2002;360:75
2、260.P=0.069RR 1.13(95%CI 0.991.28)CaptoprilLosartanMonths after randomizationEndpointrate(%)0061218243036Secondary and tertiary endpointsDickstein et al.Lancet 2002;360:75260.RR 1.19(95%CI 0.981.43)P=0.072CaptoprilLosartan05101551015Sudden cardiac death or cardiac arrestRR 1.03(95%CI 0.891.18)P=0.72
3、ReinfarctionMonths after randomizationHospitalization(%)006121824303620406080All-cause hospitalizationRR 1.03(95%CI 0.971.10)P=0.36CaptoprilLosartanDickstein et al.Lancet 2002;360:75260.IIa Angiotensin II receptor blockers are reasonable to use as alternatives to ACE inhibitors as first-line therapy
4、 for patients with mild to moderate HF and reduced LVEFMcMurray JJV et al.Lancet.2003;362:761-71.Candesartan in Heart failure:Assessment of Reduction in Mortality and morbidity(CHARM)-AddedRandomized,double-blindNYHA class IIIV,LVEF 40%,stable ACEI dose for 30 daysN=2548Candesartan 32 mg qdn=1276Pla
5、cebo n=1272Median follow-up:41 monthsPrimary outcome:CV death or hospitalization for HF ACEI=angiotensin-converting enzyme inhibitorN=2548McMurray JJV et al.Am Heart J.2006;151:985-91.Recommended dose of ACEICHARM prespecifiedMaximum dose of ACEIFDA 2005CHARM-AddedCHARM-AlternativePooled results(low
6、 LVEF patients)NoYesNoYes125712912019529254820284576 0.26 0.29Patients(n)Candesartan betterPlacebo betterP value for interaction0.60.811.2Hazard ratio(95%Cl)McMurray JJV et al.Am Heart J.2006;151:985-91.替米沙坦雷米普利替米沙坦+雷米普利随访时间（年）累积事件发生率（%）Kuenzli A.European Society of Cardiology 2009 Congress;August 30-September 2,2009;Barcelona,Spain.
