Candesartan effectiveness in essential arterial hypertension and renal arterial hypertension
Abstract
Aim. To study candesartan effectiveness and tolerability in essential arterial hypertension (ГАН) and AH associated with chronic renal disease.
Material and methods. This 12-week open, controlled study included 14 patients (mean age 43,4±16 years) with diagnosed ГАН (n=9) or secondary AH of renal etiology (n=5). At baseline and after 12 weeks of candesartan therapy, office blood pressure (BP) measurement, 24-hour BP monitoring (BPM), vectorcardiography and decar-tography measurements of plasma renin activity, aldosterone, potassium levels and microalbuminuria (MAU) were performed.
Results. Target BP level <140/90 mm Hg was achieved in 6 out of 14 patients (42,8 %). Additional hydrochlorothiazide (HCT) therapy increased antihypertensive effect of candesartan. On average, MAU reduced from 63,5±16,8 to 31,7±24,4 mg/d (p<0,0001).
Conclusion. Candesartan therapy, especially combined with HCT, was effective in patients with mild to moderate AH, providing organo-protection. It could be recommended not only in ГАН, but also in symptomatic AH associated with chronic renal disease.
About the Authors
N. M. Chikhladze
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies. Moscow
Russian Federation
Russian Federation
O. A. Sivakova
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies. Moscow
Russian Federation
Russian Federation
E. V. Blinova
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies. Moscow
Russian Federation
Russian Federation
T. A. Sakhnova
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies. Moscow
Russian Federation
Russian Federation
I. P. Kolos
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies. Moscow
Russian Federation
Russian Federation
G. N. Litonova
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies. Moscow
Russian Federation
Russian Federation
I. E. Chazova
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies. Moscow
Russian Federation
Russian Federation
References
1. Andersson OK, Neldham S. The antihypertensive effect and tolerability of candesartan cilexetil, a new generation angiotensin II antagonist, in comparison with losartan. Blood press 1998; 7: 53-9.
2. Bakris G, Gradman A, Reif M, et al. Antihypertensive efficacy of candesartan in comparison to losartan: the CALM study. J Clin Hypertens (Greenwich) 2001; 3: 16-21.
3. Farsang C, Kawecka-Jjasziz K, Langan J, etal. 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.
4. Mimran A, Aifaro V. Candesartan: nephroprotective effects and treatment of diabetic nephropathy. Drugs of Today 2003; 39(6): 439-50.
5. Mitsunami K, Inoue S, Maeda K, et al. Three-month effects of candesartan cilexetil, an angiotensin II type 1 (ATI) receptor antagonist, on left ventricular mass and hemodynamics in patients with essential hypertension. Cardiovascular Drugs and Therapy 1998; 12:469-74.
6. Блинова Е.В., Сахнова ТА., Саидова МА. и др. Информативность показателей ортогональной электрокардиограммы в диагностике гипертрофии левого желудочка. Тер 2007; 4: 15-8.
7. Meredith P. Clinical comparative trials of angiotensine II type 1 (ATI) -receptor blockers. Blood press 2001; 10(Suppl 3): 11-7.
8. Fridman K, Wysoky M, Friberg P, et al. A comparison of the inhibitory effects of candesartan cilexetil, losartan and valsartan on the response to angiotensin II in hypertensive patients. Am J Hypertens 1999; 12: 135A.
9. Zanchetti A, Omboni S, on behalf of the Italian Candesartan Study Group. Comparison of candesartan versus enalapril in essential hypertension. Am J Hypertens 2001; 14: 129-34.
10. Parving HH, Lehnert H, Brohner-Mortensen J, et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001, 345: 870-8.
11. Mogensen CE, Neldam S, Tikkanen I, et al. Randomised controlled trial on 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.
12. WheeldonN,VibertiG,fortheMARVAL Trial. Microalbuminuria reduction with valsartan, Am J Hypertens 2001; 14: 2A.
13. Rossing K, Christensen PK, Hansen BV, et al. Optimal dose of candesartan for renoprotection in type 2 diabetic patients with nephropathy. Diabetic Care 2003; 26: 150-5.
14. Kurokawa K, Abe K, Saruta T, et al-Antiproteinuric effect of candesartan cilexetil in patients with chronic glomerulonephritis. J Ren Angiotens Aldoster Syst 2002; 3(3): 167-75.
15. Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861-9.
16. Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensine-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001;345:851-60.
17. Gansevoort RT, de Zeeuw D, de Long PE. Is the antiproteinuric effect of ACE inhibition mediated by interference in the reninangiotensin system? Kidney Int 1994; 45: 861-7.
18. Andersen S, Jacobsen P, Tarnow L, et al. Time course of the antiproteinuric and antihypertensive effect of Losartan in diabetic nephropathy. Nephrol Dial Transplant 2001; 16: 771-5.
19. Apperloo AJ, de Zeeuw D, de Long PE. Short-term antiproteinuric response to antihypertensive treatment predicts long-term GFR decline in patients with non-diabetic renal disease. Kidney Int 1994; 45(Suppl.45): S174-8.
20. de Jong PE, Navis Gj, de Zeeuw D. Renoprotective therapy: titration aganist urinary protein excretion. Lancet 1999; 354: 352-3.
21. Rossing P, HommelE, SmidtUM, et al. Reduction in albuminuria predicts diminished progression in diabetic nephropathy. Kidney Int 45 1994; (Suppl.45): S145-9.
22. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts a beneficial effects on diminishing the progression of human diabetic nephropathy during antihypertensive treatment. Diabetologia 1994; 37: 511-6.
23. Gisen Group. Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, nondiabetic nephropathy. Lancet 1997; 349: 1857-63.
Review
For citations:
Chikhladze N.M., Sivakova O.A., Blinova E.V., Sakhnova T.A., Kolos I.P., Litonova G.N., Chazova I.E. Candesartan effectiveness in essential arterial hypertension and renal arterial hypertension. Cardiovascular Therapy and Prevention. 2008;7(7):34-38. (In Russ.)
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