A forced titration study of antihypertensive efficacy of candesartan cilexetil in comparison to losartan: CLAIM Study II

Dg, Vidt; Wb, White; Ridley, Emily; Rahman, M.; Harris, Susan; Vendetti, J; Michelson, EL; Wang, R

doi:10.1038/sj.jhh.1001205

Cited by 49 publications

(36 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13,24 Age, gender and race did not play a substantial role in the differential effects between telmisartan-HCTZ 80/25 and valsartan-HCTZ 160/25. The antihypertensive efficacy differences between telmisartan-HCTZ and valsartan-HCTZ, although small, bear clinical significance.…”

Section: Discussionmentioning

confidence: 92%

“…All combinations with the angiotensin receptor blockers were developed initially with HCTZ at a dose of 12.5 mg; these combinations typically show additive effects on blood pressure lowering regardless of which angiotensin receptor blocker was evaluated. 6,[19][20][21][22][23][24] Incremental BP-lowering effects have been observed with larger doses of hydrochlorothiazide, that is, 25 mg, in combination with the angiotensin receptor blockers, 6,19 which led to the development of the fixed-dose combination formulations used in our trial. In an earlier study by Benz and coworkers, 19 valsartan-HCTZ at a dose of 160/25 mg lowered the BP by 22/15 mm Hg compared with 18/ 14 mm Hg for valsartan-HCTZ at a dose of 160/ 12.5 mg. Trenkwalder et al 25 also showed that patients not controlled on valsartan-HCTZ 160/ 12.5 mg had an additional 8.4/8.3 mm Hg reduction in BP when the diuretic dose was increased to 25 mg.…”

Section: Principal Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

2009

View full text Add to dashboard Cite

The antihypertensive effects of telmisartan 80 mg versus valsartan 160 mg, both combined with hydrochlorothiazide (HCTZ) 25 mg, were assessed in a pooled analysis from two large trials with identical study designs in patients with stage 1-2 hypertension. The trials were double-blind with a 4:4:1 randomization scheme to compare once-daily telmisartan 80 mg and HCTZ 25 mg versus once-daily valsartan 160 mg and HCTZ 25 mg versus once-daily placebo on reductions in clinic blood pressure (BP). The primary end point was changes from baseline in BP at the end of 8 weeks. In total, 2121 patients were randomized (telmisartan-HCTZ, 942, valsartan-HCTZ, 952, and placebo, 227) and had baseline seated BPs of 154/102 and 155/102 mm Hg in the two studies, respectively. Changes from baseline in BP after administration of telmisartan-HCTZ (À24.5/ À18.0 mm Hg) were significantly greater than for both placebo (À4.1/À6.5 mm Hg) and valsartan-HCTZ (À22.3/ À16.8 mm Hg) (versus placebo, Po0.0001 for systolic and diastolic BP; versus valsartan-HCTZ, P ¼ 0.0004 for systolic BP and P ¼ 0.0019 for diastolic BP). Adverse event rates were higher in the placebo group than in the active treatment groups (placebo, 41%, telmisartan-HCTZ, 30%, and valsartan-HCTZ, 30%, Po0.05). These data confirm that telmisartan-HCTZ at doses of 80/25 mg lowered systolic and diastolic BP to a greater extent than valsartan-HCTZ at doses of 160/25 mg in stage 1-2 hypertension. The magnitude of the BP-lowering effect provides support for the use of angiotensin receptor blockers with higher doses of a thiazide diuretic (25 mg) to improve hypertension control.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Principal Findingsmentioning

confidence: 99%

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

2009

View full text Add to dashboard Cite

show abstract

“…[13][14][15][16][17][18][19][20][21][22][23][24][25] A total of 4066 patients were included in the analysis, and the design and patient characteristics of randomized clinical trials included in the meta-analysis are shown in Table 1. The majority of the trials had a randomized, doubleblind, parallel group design.…”

Section: Resultsmentioning

confidence: 99%

Comparison of the efficacy of candesartan and losartan: a meta-analysis of trials in the treatment of hypertension

2009

View full text Add to dashboard Cite

Informed by the findings from prospective observational studies and randomized outcome trials, guidelines for the management of hypertension acknowledge that the benefit of treatment can be attributed largely to blood pressure (BP) reduction. Therefore, quantification of differential BP lowering of different agents within classes of anti-hypertensives is of practical importance. The objective of this analysis was to compare the efficacy of candesartan and losartan with respect to reduction in systolic and diastolic BP (SBP and DBP). A systematic literature search of databases from 1980 to 1 October 2008 identified 13 studies in which candesartan and losartan were compared in randomized trials in hypertensive patients. Data from 4066 patients were included in the analysis using a random effect model. Mean changes in SBP and DBP were compared for each drug alone and after stratification for dose and for combination with hydrochlorothiazide (HCTZ). On the basis of all the data, the weighted mean difference favoured candesartan-3.22 mm Hg (95% confidence interval (CI) 2.16, 4.29) for SBP and 2.21 mm Hg (95% CI 1.34, 3.07) for DBP. These findings were consistent when analyses according to dose and combination with HCTZ were carried out. Thus, it can be concluded that at currently recommended doses, candesartan is more effective than losartan in lowering BP.

show abstract

“…At baseline, mean clinic SBP was similar in all 3 treatment groups (Table I). At week 24, statistically significantly greater decreases in the change from baseline to week 24 in mean clinic SBP were observed for each of the AZL-M treatment groups (40 mg and 80 mg) compared with VAL 320 mg (P=.015 and P<.001, respectively), and the mean decrease was numerically greater with AZL-M 80 mg () 16.92 mm Hg) than with AZL-M 40 mg ()14.86 mm Hg). …”

Section: Changes In 24-hour Mean Sbp and Clinic Sbpmentioning

confidence: 98%

Comparison of the Novel Angiotensin II Receptor Blocker Azilsartan Medoxomil vs Valsartan by Ambulatory Blood Pressure Monitoring

Sica

White

Weber

et al. 2011

J of Clinical Hypertension

114

View full text Add to dashboard Cite

Azilsartan medoxomil (AZL-M) is a unique angiotensin II receptor blocker (ARB) under development for the treatment of hypertension. To compare this ARB with another in the class, the authors studied the effects of AZL-M and valsartan (VAL) in 984 patients with primary hypertension in a randomized, double-blind, multicenter study using ambulatory and clinic blood pressure (BP) measurements. The primary end point was change from baseline in 24-hour mean ambulatory systolic BP following 24 weeks of treatment. Hierarchical analysis testing for noninferiority was followed by superiority testing of AZL-M (80 mg then 40 mg) vs VAL. The mean age of participants was 58 years, 52% were men, and 15% were black. Baseline 24-hour mean systolic BP was similar (approximately 145.6 mm Hg) in each group. AZL-M 40 mg and 80 mg lowered 24-hour mean systolic BP ()14.9 mm Hg and )15.3 mm Hg, respectively) more than VAL 320 mg ()11.3 mm Hg; P<.001 for 40-mg and 80-mg comparisons vs VAL). Clinic systolic BP reductions were consistent with the ambulatory results ()14.9 mm Hg for AZL-M 40 mg and )16.9 mm Hg for AZL-M 80 mg vs )11.6 mm Hg for VAL; P=.015 and P<.001, respectively). The reductions in 24-hour mean and clinic diastolic BPs were also greater with both doses of AZL-M than with VAL (P .001 for all comparisons). Small, reversible changes in serum creatinine occurred more often with AZL-M than with VAL; otherwise, safety and tolerability parameters were similar among the three groups. These data demonstrate that AZL-M across the effective dose range had superior efficacy to VAL at its maximal recommended dose without any meaningful increase in adverse events. These findings suggest that AZL-M could provide higher rates of hypertension control compared with other ARBs in the class. J Clin Hypertens (Greenwich). 2011;13:467-472. Ó2011 Wiley Periodicals, Inc.The effective lowering of blood pressure (BP) in patients with hypertension is essential to the lessening of cardiovascular events, 1,2 and various guideline-promulgating groups have advocated BP levels <140 ⁄ 90 mm Hg in patients without evidence of target-organ damage and <130 ⁄ 80 mm Hg in patients with either diabetes or heart or kidney disease. 3,4 A variety of drug classes are available for the treatment of hypertension. Head-to-head studies have shown comparable BP reduction between and within various drug classes, including angiotensin-converting enzyme inhibitors, calcium channel blockers, and angiotensin II receptor blockers (ARBs). 5,6 What typically separates these drug classes has been their sideeffect profile, with the popularity of ARBs, as such, relating to a tolerability profile similar to placebo. 7-12Azilsartan medoxomil (AZL-M) is a prodrug that is quickly hydrolyzed to the active moiety azilsartan, a potent and highly selective ARB with estimated bioavailability of 60% and elimination half-life of approximately 12 hours. 13 The major metabolite, M-II, is formed via CYP2C9 and has low affinity for the angiotensin type 1, or AT1, receptor. Based on doseranging...

show abstract

A forced titration study of antihypertensive efficacy of candesartan cilexetil in comparison to losartan: CLAIM Study II

Cited by 49 publications

References 10 publications

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

Comparison of the efficacy of candesartan and losartan: a meta-analysis of trials in the treatment of hypertension

Comparison of the Novel Angiotensin II Receptor Blocker Azilsartan Medoxomil vs Valsartan by Ambulatory Blood Pressure Monitoring

Contact Info

Product

Resources

About