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(Hypertension. 2000;36:454.)
© 2000 American Heart Association, Inc.

Scientific Contributions

Efficacy of Candesartan Cilexetil Alone or in Combination With Amlodipine and Hydrochlorothiazide in Moderate-to-Severe Hypertension

Graham A. MacGregor; J. Reuven Viskoper; Tarek F.T. Antonios; Feng J. He; on behalf of the UK and Israel Candesartan Investigators

From the Blood Pressure Unit, Department of Medicine, St. George’s Hospital Medical School, London, UK, and Barzilai Medical Center (J.R.V.), Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel.

Correspondence to Prof Graham MacGregor, Blood Pressure Unit, Department of Medicine, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.

Abstract—This multicenter study evaluated the efficacy of candesartan cilexetil, an angiotensin II type 1 receptor antagonist, used alone or in combination with amlodipine or in combination with amlodipine and hydrochlorothiazide in the treatment of patients with moderate-to-severe essential hypertension. After a 2-week, single-blind, placebo run-in period, patients entered a 12-week, open-label, dose-titration period. The candesartan cilexetil dose was increased from 8 to 16 mg once daily; amlodipine (5 mg once daily), hydrochlorothiazide (25 mg once daily), and additional medication were also added sequentially if necessary. Patients then entered a final 4-week, parallel-group, double-blind, randomized, placebo-controlled withdrawal period of candesartan alone. A total of 216 patients were recruited. After a 2-week run-in period on placebo tablets, mean sitting blood pressure (BP) was 175/108 mm Hg. At the end of the 12-week dose-titration/maintenance period, mean sitting BP fell to 141/88 mm Hg. In 67 patients who were randomized to placebo and had their candesartan withdrawn, there was a highly significant increase in mean systolic/diastolic BP (13/6 mm Hg) compared with those patients who continued with candesartan (ANCOVA, P<0.0001). In conclusion, candesartan cilexetil is an effective BP-lowering drug when used alone or in combination with amlodipine or amlodipine plus hydrochlorothiazide in the treatment of moderate-to-severe essential hypertension. The drug was well tolerated throughout the investigation period.

Key Words: candesartan cilexetil • amlodipine • hydrochlorothiazide • hypertension, essential • angiotensin II receptors antagonists

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