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  • Title: A Combination of Candesartan Cilexetil/hydrochlorothiazide (HCTZ), 8/12.5 mg, has a Similar Antihypertensive Efficacy and is Better Tolerated than Lisinopril/HCTZ, 10/12.5 mg.
    Author: T McINNES G, Istad H, Keinänen-Kiukaanniemi S, VAN Mierlo HFCM.
    Journal: Blood Press; 2000; 9(sup1):61. PubMed ID: 28425809.
    Abstract:
    Monotherapy with an antihypertensive agent is likely to achieve a desirable lowering of blood pressure in about 50% of patients. The remaining proportion of patients are likely to be only partially responsive or unresponsive, even if appropriate dose adjustments are made. For these patients, combination therapy usually leads to better control of hypertension. The aim of this study was to compare the antihypertensive effect and tolerability of a once-daily combination of the angiotensin II type 1 (AT 1 ) receptor blocker candesartan cilexetil, 8 mg, and the diuretic hydrochlorothiazide (HCTZ), 12.5 mg, with a combination of the angiotensin-converting enzyme inhibitor, lisinopril, 10 mg, and HCTZ, 12.5 mg, in patients with primary hypertension. The study included men and women, 20-80 years of age, with sitting diastolic blood pressure (DBP) of 95-114 mm Hg. After a run-in period of 2 weeks on any antihypertensive monotherapy, 355 patients were randomized to double-blind treatment with either a combination of candesartan cilexetil/HCTZ, 8/12.5 mg, or a combination of lisinopril/HCTZ, 10/12.5 mg, for 26 weeks. Blood pressure was measured 24 h after dose intake, the primary efficacy variable being the change in sitting DBP at trough between baseline and 26 weeks of treatment. Reductions in mean sitting DBP after 26 weeks were similar for both combination treatments. In addition, no differences were found between the two treatment groups regarding standing DBP, sitting and standing systolic blood pressure, heart rate, and the proportion of responders and controlled patients. Significantly fewer patients reported at least one adverse event with candesartan cilexetil/HCTZ than with lisinopril/HCTZ (68.9% vs 79.5%, p = 0.02; see Table). Furthermore, the proportion of patients spontaneously reporting cough was markedly higher in the lisinopril/HCTZ group (23.9%) than in the candesartan cilexetil/HCTZ group (5.0%). Thus, although the combinations of candesartan cilexetil/HCTZ, 8/12.5 mg once daily, and lisinopril/HCTZ, 10/12.5 mg once daily, had similar antihypertensive efficacy in patients with mild to moderate hypertension during the 26-week treatment period, candesartan cilexetil/HCTZ was significantly better tolerated than lisinopril/HCTZ.
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