Antihypertensive Efficacy of Candesartan in Comparison to Losartan: The CLAIM Study

Abstract

An 8-week, multicenter, double-blind, randomized, parallel-group, forced-titration A ngiotensin II receptor blockers (ARBs) inhibit the renin-angiotensin system by selectively blocking the AT 1 subtype of angiotensin II receptor. Various studies have demonstrated their effectiveness in lowering blood pressure with an excellent tolerability and safety profile. 1 Further large-scale studies are being conducted to determine whether the use of this class of drugs will result in end-organ protection, as well as beneficial effects on morbidity and mortality. 2 Different ARBs vary in their binding characteristics to the AT 1 subtype of angiotensin II receptor. Preclinical studies have demonstrated that candesartan is a highly selective, insurmountable ARB. 3 It has an in vitro affinity for the AT 1 receptor 80 times greater than that of losartan and 10 times greater than that of EXP-3174, the active metabolite of losartan. 4 However, it remains uncertain whether these differences in pharmacologic properties result in greater blood pressure (BP) lowering efficacy for candesartan, compared to that of other ARBs.

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

“…[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.…”

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

“…6 CLAIM Study I showed that at week 8, candesartan cilexetil 32 mg once daily was more effective in lowering all the measured BP parameters than losartan 100 mg once daily (P Ͻ 0. 4 In a forced titration study, candesartan cilexetil 16 mg once daily lowered 24-h ambulatory SBP/DBP more than losartan 100 mg by 4.1/1.8 mm Hg, with the difference in SBP statistically significant.…”

“…CLAIM Study I showed that candesartan cilexetil lowered all the primary and secondary BP parameters by a significantly greater amount (P Ͻ 0.05) than losartan in 654 hypertensive patients. 6 The present report summarises the findings of CLAIM Study II on 611 patients with systemic hypertension.…”

“…These studies either evaluated the starting doses of both drugs or used a response titration design for comparison of their maximum doses. [3][4][5] A fourth study by Bakris et al 6 (CLAIM Study I) and the present study (CLAIM Study II), are two identically designed, concurrently conducted, double-blind, randomised forced titration studies to provide direct comparison of the blood pressure (BP) lowering effects at once daily maximum doses. CLAIM Study I showed that candesartan cilexetil lowered all the primary and secondary BP parameters by a significantly greater amount (P Ͻ 0.05) than losartan in 654 hypertensive patients.…”

AT1-receptor blockers: differences that matter

“…25 In this study, patients were randomised to receive candesartan cilexetil, 16 mg, or losartan, 50 mg, and doses were doubled after 2 weeks; these high doses were used to ensure that maximal blood pressure responses were achieved. At 8 weeks after randomisation, trough blood pressures were reduced to a significantly greater extent with candesartan than with losartan (mean reductions 13.3/10.9 mm Hg vs 9.8/8.7 mm Hg, respectively, P Ͻ 0.001).…”