Randomized trial comparing the velocities of the antihypertensive effects on home blood pressure of candesartan and candesartan with hydrochlorothiazide

Abstract

We aimed to evaluate the hypotensive effect and the time to attain the maximal antihypertensive effect (stabilization time) of 8 mg candesartan/6.25 mg hydrochlorothiazide (HCTZ) combination therapy (combination regimen) and therapy with an increased candesartan dose (12 mg; maximum dose regimen) using home blood pressure (BP) measurements. A prospective, multicenter, open-label, randomized, comparative trial was conducted. Essential hypertensive patients who failed to achieve adequate BP control (systolic BP (SBP) ⩽ 135 mm Hg) on 8 mg candesartan alone were randomized to two groups: the combination regimen (n=103) and the maximum dose regimen (n=103). Home morning SBP reduction at 8 weeks after randomization was 11.4 ± 1.3 mm Hg in the combination regimen and 7.8 ± 1 .2 mm Hg in the maximum dose regimen. The combination regimen provided additional reduction of 4.0 mm Hg (95% confidence interval (CI): 0.8-7.2 mm Hg, P=0.01) in home morning SBP over the maximum dose regimen at 8 weeks after randomization. The maximal antihypertensive effect and stabilization time for home SBP were 9.4 mm Hg and 37.1 days (P<0.0001), respectively, with the combination regimen. The maximum dose regimen decreased home SBP with a very gentle slope, and estimated maximal effect and estimated stabilization time were not significant (P>0.2). The rate of achieving target BP (home morning SBP <135 mm Hg) was significantly higher with the combination regimen than with the maximum dose regimen (52.4 vs. 30.1%, P=0.002). In conclusion, changing from 8 mg candesartan to combination therapy was more effective in reducing home SBP and achieving goal BP more rapidly than increasing the candesartan dose.

Comparison of different schedules of nocturnal home blood pressure measurement using an information/communication technology‐based device in hypertensive patients

“…Even in the present clinical trial, although all participants were available to measure their nocturnal home BP on the first night, they were not able to continue the measurements for the seven consecutive nights of either phase of the protocol. In a previous study, one of the main purposes of which was to assess the changes in nocturnal home BP over three nights following an antihypertensive medication, only 26% of the 206 participants successfully measured their nocturnal home BP on all three nights . On the other hand, since there has been much evidence that nocturnal BP is a better predictor of future cardiovascular events than daytime BP, we concluded that nocturnal BP should be measured in clinical practices, and thus it is important to measure nocturnal home BP values over the long term under standard conditions.…”

“…On the other hand, participants are likely to measure nocturnal BP levels depending on their own lifestyle. Recently developed HBPM devices permit participants to set specific lengths of time after their chosen bedtime for the measurement of nocturnal BPs . Although there may be differences between the nocturnal BP values measured at intervals after a participant‐specified bedtime and those measured at fixed time points, the previous studies on nocturnal HBPM have not taken such measurement conditions into consideration .…”