IJCM  Vol.2 No.2 , May 2011
Efficacy and Tolerability of Candesartan Cilexetil and Amlodipine in Patients with Poorly Controlled Essential Hypertension
ABSTRACT
Current treatment guidelines for hypertension in both Europe and the USA stress the importance of aggressive blood pressure control. When monotherapy is not enough to reach treatment targets, there is a need for combination regi-mens that have both high efficacy and good tolerability. The aim of this study is to evaluate the efficacy and toler-ability of the combination therapy candesartan and amlodipine in patients with hypertension not satisfactorily controlled by monotherapy. Patients with uncomplicated essential hypertension not satisfactorily controlled by monotherapy, which is candesartan 8 mg or amlodipine 5 mg, were eligible. Candesartan 8 mg and amlodipine 5 mg were given for 12 weeks. 13 patients who received candesartan 8 mg previoursly were assigned to the candesartan group and 8 patients who received amlodipine 5 mg previoursly were assigned to the amlodipine group. Sitting systolic blood pressure (SBP) at baseline was 151.9 ± 11.6 mmHg in the candesartan group, and 154.6 ± 7.6 mmHg in the amlodipine group. Sitting diastolic blood pressure (DBP) was 93.2 ± 13.1 in the candesartan group, and 80.4 ± 14.7 in the amlodipine group. DBP in the amlodipine group was lower than that in the cadesartan group (P = 0.036). After the combination therapy, SBP was significantly reduced in the two groups. DBP showed significant reduction in the amlodipine group. The rate of achieving blood pressure goals was 4% at baseline and significantly increased to 58% after the combination therapy. These results showed that candesartan 8 mg/amlodipine 5 mg are effective lowering blood pressure after 12 weeks in patients not adequately controlled by monotherapy.

Cite this paper
nullK. Nishio, T. Kondo and Y. Kobayashi, "Efficacy and Tolerability of Candesartan Cilexetil and Amlodipine in Patients with Poorly Controlled Essential Hypertension," International Journal of Clinical Medicine, Vol. 2 No. 2, 2011, pp. 64-68. doi: 10.4236/ijcm.2011.22012.
References
[1]   [1] R. Hübner, A. M. H?gemann, M. Sunzel and J. G. Riddell, “Pharmacokinetics of Candesartan after Single and Re-peated Doses of Candesartan Cilexetil in Young and Eld-erly Healthy Volunteers,” Journal of Human Hyperten-sion, Suppl. 2, 1997, pp. S19-S25.

[2]   [2] P. Sever and H. Holzgreve, “Long-Term Efficacy and Tolerability of Candesartan Cilexetil in Patients with Mild to Moderate Hypertension,” Journal of Human Hy-pertension, Suppl. 2, 1997, pp. S69-S73.

[3]   [3] D. Elmfeldt, M. George, R. Hübner and B. Olofsson, “Candesartan Cilexetil, a New Generation Angiotensin II Antagonist, Provides Dose Dependent Antihypertensive Effect,” Journal of Human Hypertension, Suppl. 2, 1997, pp. S49-S53.

[4]   [4] C. E. Mogensen, S. Neldam, I. Tikkanen, S. Oren, R. Viskoper, R. W. Watts, and M. E. Cooper, “Randomised Controlled 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, Vol. 321, No. 7274, 2000, pp. 1440-1444. doi:10.1136/bmj.321.7274.1440

[5]   [5] K. Kurokawa, “Effects of Candesartan on the Proteinuria of Chronic Glomerulonephritis,” Journal of Human Hy-pertens, Suppl. 1, 1999, pp. S57-S60.

[6]   [6] M. J. Krimholtz, J. Karalliedde, S. Thomas, R. Bilous, and G. Viberti, “Targeting Albumin Excretion Rate in the Treatment of the Hypertensive Diabetic Patient with Re-nal Disease,” Journal of the American Society Nephrol-ogy, Vol. 16, No. 3, Suppl. 1, 2005, pp. S42-S47. doi:10.1681/ASN.2004110973

[7]   [7] S. D. Solomon, D. Wang, P. Finn, H. Skali, L. Zornoff, J. J. McMurray, K. Swedberg, S. Yusuf, C. B. Granger, E. L. Michelson, S. Pocock and M. A. Pfeffer, “Effect of Can-desartan on Cause-Specific Mortality in Heart Failure Pa-tients: The Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) Pro-gram,” Circulation, Vol. 110, No. 2073, 2004, pp. 2180-2183. doi:10.1161/01.CIR.0000144474.65922.AA

[8]   [8] J. B. Young, M. E. Dunlap, M. A. Pfeffer, J. L. Probstfield, A. Cohen-Solal, R. Dietz, C. B. Granger, J. Hradec, J. Kuch , R. S. McKelvie, J. J. McMurray, E. L. Michelson, B. Olofsson, J. Ostergren, P. Held, S. D. Solomon, S. Yusuf, and K. Swedberg, “Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) Investigators and Committees. Mortality and Morbidity Reduction with Candesartan in Patients with Chronic Heart Failure and Left Ventricular Systolic Dysfunction: Resu

[9]   [9] E. O’Meara, S. Solomon, J. McMurray, M. Pfeffer, S. Yusuf, E. Michelson, C. Granger, B. Olofsson, J. B. Young and K. Swedberg, “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,” Euro-pean Heart Journal, Vol. 25, No. 21, 2004, pp. 1920-1926. doi:10.1016/j.ehj.2004.07.025

[10]   [10] B. J. Materson, D. J. Reda, W. C. Cushman, B. M. Massie, E. D. Freis, M. S. Kochar, R. J. Hamburger, C. Fye, R. Lakshman, J. Gottdiener, E. A. Ramirez and G. Willium, “Single-Drug Therapy for Hypertension in Men. A Com-parison of Six Antihypertensive Agents with Placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents,” The New England Journal of Medicine, Vol. 328, No. 13, 1993, pp. 914-921. doi:10.1016/j.ehj.2004.07.025

[11]   [11] A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green , J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr and E. J. Roccella; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee, “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure:

[12]   [12] G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G Grassi, A. M. Heagerty, S. E. Kjeldsen, S. Laurent, K. Narkiewicz, L. Ruilope, A. Rynkiewicz, R. E. Schmieder, H. A. Boudier, A. Zanchetti, A. Vahanian, J. Camm, R. De Caterina , V. Dean, K. Dickstein, G. Filippatos, C. Funck-Brentano, I. Hellemans, S. D. Kristensen, K. McGregor, U. Sechtem, S. Silber, M. Tendera, P. Widimsky, J. L. Zamorano, S. Erdine, W. Kiowski, E. Agabiti-Rosei, E. Ambrosioni, L. H. Lindholm, M. Viigimaa

[13]   [13] W. C. Cushman, C. E. Ford, J. A. Cutler, K. L. Margolis, B. R. Davis, R. H. Grimm, H. R. Black, B. P. Hamilton, J. Holland, C. Nwachuku, V. Papademetriou, J. Probstfield, J. T. Wright Jr, M. H. Alderman, R. J. Weiss, L. Piller, J. Bettencourt and S. M. Walsh; ALLHAT Collaborative Research Group, “Success and Predictors of Blood Pressure Control in Diverse North American Settings: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT),” The Journal of Clinical Hyperte

[14]   [14] R. A. Kloner, M. Weinberger, J. L. Pool, S. G. Chrysant, R. Prasad, S. M. Harris, T. M. Zyczynski, N. K. Leidy and E. L. Michelson; Comparison of Candesartan and Amlodipine for Safety, Tolerability and Efficacy (CAS-TLE) Study Investigators, “Comparative Effects of Can-desartan Cilexetil and Amlodipine in Patients with Mild Systemic Hypertension. Comparison of Candesartan and Amlodipine for Safety, Tolerability and Efficacy (CAS-TLE) Study Investigators,” American Journal of Cardi-ology, Vol. 87, No.

[15]   [15] C. Farsang, K. Kawecka-Jaszcz, J. Langan, F. Maritz and F. Zannad, “Antihypertensive Effects and Tolerability of Candesartan Cilexetil alone and in Combination with Amlodipine,” Clinical Drug Investigation, Vol. 21, No. 1, 2001, pp. 17-23.

[16]   [16] J. Greven, “Effect of the Novel T-Selective Calcium Channel Antagonist Mibefradil on Kidney Function in Comparison with Amlodipine,” Arzneimittelforschung, Vol. 48, No.8, 1998, pp. 806-810.

[17]   [17] J. L. Andersen, N. C. Sandgaard and P. Bie, “Volume Expansion during Acute Angiotensin II Receptor (AT(1)) Blockade and NOS Inhibition in Conscious Dogs,” American Journal of Physiology-Regulatory Integrative and Comparative Physiology, Vol. 282, No. 4, 2002, pp. R1140-R1148.

[18]   [18] K. Ueshima, K. Oba, S. Yasuno, A. Fujimoto, T. Sato, K. Fukiyama, J. Azuma, T. Ogihara, T. Saruta and K. Nakao; Candesartan Antihypertensive Survival Evaluation in Japan Trial Group, “Long-Term Effects of Candesartan and Amlodipine on Cardiovascular Mortality and Morbidity in Japanese High-Risk Hypertensive Patients: Rationale, Design, and Characteristics of Candesartan Antihypertensive Survival Evaluation in Japan Extension (CASE-J Ex),” Contemporary Clinicla Trials, Vol. 30, No.1, 2009, pp. 97-101.

 
 
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