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Efficacy and tolerability of candesartan cilexetil/hydrochlorothiazide and amlodipine in patients with poorly controlled mild-to-moderate essential hypertension

Department of Internal Medicine and Therapeutics, Centro per l'Ipertensione e la Fisiopatologia Cardiovascolare, University of Pavia, Pavia, r.fogari{at}unipv.it

Amedeo Mugellini

Department of Internal Medicine and Therapeutics, Centro per l'Ipertensione e la Fisiopatologia Cardiovascolare, University of Pavia, Pavia

Giuseppe Derosa

Department of Internal Medicine and Therapeutics, Centro per l'Ipertensione e la Fisiopatologia Cardiovascolare, University of Pavia, Pavia

The antihypertensive efficacy and tolerability of combination therapy with candesartan cilexetil, 16 mg plus hydrochlorothiazide (CC/HCTZ), 12.5 mg was compared with that of amlodipine, in a multicentre, double-blind, randomised, parallel-group study in patients with mild-to-moderate essential hypertension inadequately controlled by monotherapy.After a two week run-in period on existing therapy, patients with a sitting diastolic blood pressure (DBP) of 90—110 mmHg and a sitting systolic blood pressure (SBP) < 180 mmHg were switched to either CC/HCTZ (n=101) or amlodipine (n=102), once-daily by mouth. After eight weeks of AA treatment, both regimens reduced mean trough blood pressure (BP) by a similar amount: mean sitting SBP/DBP reductions were -15.4/-11.9 mmHg for CC/HCTZ, and -15.7/-12.0 mmHg for amlodipine (group differences, p=0.835/0.963). The BP of 84.2% of patients on CC/HCTZ and 84.5% on amlodipine was controlled (sitting DBP < 90 mmHg and sitting SBP < 140 mmHg) (p=1.00). Six (5.9%) patients on CC/HCTZ and 18 (17.6%) on amlodipine discontinued treatment, including one (1% O ) and 12 (11.8%) owing to ad C verse events R (p<0.001).The most common adverse event was peripheral oedema, which occurred in two patients on CC/HCTZ and 19 on amlodipine. In conclusion, CC/HCTZ and amlodipine were equally effective in reducing BP in hypertensive patients not controlled by monotherapy, but CC/HCTZ was much better tolerated.Tolerance is an important clinical consideration in the chronic treatment of an asymptomatic disease.

Key Words: amlodipine • candesartan • hydrochlorothiazide • hypertension

References

• Asmar R. Targeting effective BP control with angiotensin receptor blockers. Int J Clin Pract 2006;60:315-20.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Belz GG Pharmacological differences among angiotensin receptor antagonists. Blood Pressure Suppl 2001;2:13-18.
• Lacouciere Y., Asmar R. A comparison of the efficacy and duration of action of candesartan cilexetil and losartan, as assessed by clinic and ambulatory blood pressure after a missed dose, in truly hypertensive patients: a placebo-controlled forced titration study. Am J Hypertens 1999;12:1181-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Gradman AH, Lewin A., Bowling BT et al. Candesartan versus Losartan Efficacy Comparison (CANDLE) Study Group. Comparative effects of candesartan cilexetil and losartan in patients with systemic hypertension. Heart Disease 1999;1:52-7.[Medline] [Order article via Infotrieve]
• Fridman KU, Elmfeldt D., Wysocki M., Friberg P., Andersson OK Influence of AT1-receptor blockade on blood pressure, renal haemodynamics and hormonal responses to intravenous angiotensin II infusion in hypertensive patients. Blood Pressure 2002;11:244-52.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Farsang C., Kawecka-Jaszcz K., Langan Maritz F., Zanmad F., for the Multicentre Study Group. Antihypertensive effects and tolerability of candesartan cilexetil alone and in combination with amlodipine. Clin Drug Invest 2001;2:17-23.
• Kloner RA, Weinberger M., Pool JL et al. Comparison of Candesartan and Amlodipine for Safety, Tolerability and Efficacy (CASTLE) Study Investigators. Comparative effects of candesartan cilexetil and amlodipine in patients with mild systemic hypertension. Am J Cardiol 2001;87:727-31.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Sever P., Holzgreve H. Long-term efficacy and tolerability of candesartan cilexetil in patients with mild to moderate essential hypertension. J Hum Hy P pertens 1997;11 (suppl 2):S69-S73.
• Reif M., White WB, Fagan TC et al. Effects of candesartan 1998;82:961-5. cilexetil in patients with systemic hypertension. Am J Cardiol[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Mogensen CE, Neldam S., Tikkaanen I. et al. Randomised control trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 2000;321:1440-4.[Abstract/Free Full Text]
• Kurokawa K. Effects of candesartan on the proteinuria of chronic glomerulonephritis. J Hum Hypertens 1999;13(suppl 1):S57-S60.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Krimholtz MJ, Karalliedde J., Thomas S., Bilous R., Viberti G. Targeting albumin excretion rate in the treatment of the hypertensive diabetic patient with renal disease. J Am Soc Nephrol 2005;16:S42-S47.[Abstract/Free Full Text]
• Solomon SD, Wang D., Finn P. et al. Effect of candesartan on cause-specific mortality in heart failure patients. The Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) Program. Circulation 2004;110:2180-3.[Abstract/Free Full Text]
• Young JB, Dunlap ME, Pfeffer MA et al. Mortality and morbidity reduction with candesartan in patients with chronic heart failure and left ventricular systolic dysfunction. Results of the CHARM low-left ventricular ejection fraction trials. Circulation 2004;110:2618-26.[Abstract/Free Full Text]
• O'Mera E., Solomon S., McMurray J. et al. Effect of candesartan on New York Heart Association functional class. Results of the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J 2004;25:1920-6.[Abstract/Free Full Text]
• Chobanian AV, Bakris GL, Black HR et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, National Heart, Lung, and Blood Institute. JAMA 2003;289:2560-72.[Abstract/Free Full Text]
• European Society of Hypertension. European Society of Cardiology Guidelines for the Management of Arterial Hypertension. J Hypertens 2003;21:1011-54.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Cushman WC, Ford CE, Cutler JA et al. Success and predictors of blood pressure control in diverse North American settings: The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens 2002;4:393-404.[CrossRef]
• Plouin PF Combination therapy with candesartan cilexetil plus hydrochlorothiazide in patients unresponsive to low-dose hydrochlorothiazide. J Hum Hypertens 1997;11 (suppl 2):S65-S66.[Web of Science][Medline] [Order article via Infotrieve]
• Philipp T., Letzel H., Arens H-J. Dose-finding study of candesartan cilexetil plus hydrochlorothiazide in patients with mild to moderate hypertension. J Hum Hypertens 1997; 11(suppl 2):S67-S68.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Campbell M., Sonkodi S., Soucek M., Wiecek A. A candesartan cilexetil/hydrochlorothiazide combination tablet provides effective blood pressure control in hypertensive patients inadequately controlled on monotherapy. Clin Exp Hypertens 2001;23:345-55.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• McInnes GT, O'Kane KPJ, Istad H., Keinänen-Kiukaanniemi S., Van Mierlo HF Comparison of the AT1receptor blocker, candesartan cilexetil, and the ACE inhibitor, lisinopril, in fixed combination with low dose hydrochlorothiazide in hypertensive patients. J Hum Hypertens 2000;14:263-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Öhman KP, Milon H., Valnes K. Efficacy and tolerability of a combination tablet of candesartan cilexetil and hydrochlorothiazide in insufficiently controlled primary hypertension - comparison with a combination of losartan and hydrochlorothiazide. Blood Pressure 2000;9:214-20.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Kloner RA, Sower JR, DiBona GF, Gaffney M., Wein M. Sex- and age-related antihypertensive effect of amlodipine. Am J Cardiol 1996;77:713-22.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Burnier M. Medication adherence and persistence as the cornerstone of effective antihypertensive therapy. Am J Hypertens 2006;19:1190-06.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Mengden T., Vetter H., Tousset E., Uen S. Management of patients with uncontrolled arterial hypertension - the role of electronic compliance monitoring, 24-h ambulatory blood pressure monitoring and Candesartan/HCT. BMC Cardiovascular Disorders 2006;6:36 (www.biomedcentral.com/1471-2261/6/36).[CrossRef][Medline] [Order article via Infotrieve]

Journal of Renin-Angiotensin-Aldosterone System, Vol. 8, No. 3, 139-144 (2007)
DOI: 10.3317/jraas.2007.023


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Fogari, R. Articles by Derosa, G. Search for Related Content PubMed PubMed Citation Articles by Fogari, R. Articles by Derosa, G. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB AMLODIPINE BESYLATE HYDROCHLOROTHIAZIDE Medline Plus Health Information High Blood Pressure Social Bookmarking                         What's this?