To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ESH: Atacand (Candesartan Cilexetil) Plus Zestril (Lisinopril) More Effective Than Single Therapy In Diabetics URL: http://www.pslgroup.com/dg/1D4346.htm Doctor's Guide June 1, 2000
GOTHENBURG, SWEDEN -- June 1, 2000 -- Combining the AT1-receptor blocker, Atacand® (candesartan cilexetil), and the ACE inhibitor, Zestril® (lisinopril), is a more effective treatment than either monotherapy for reducing blood pressure in hypertensive type 2 diabetic patients with microalbuminuria, according to the results of the CALM study, to be presented at the Tenth European Society of Hypertension meeting. The study demonstrates that Atacand is as effective as the gold standard ACE inhibitor Zestril at reducing blood pressure and microalbuminuria in hypertensive patients with type 2 diabetes. In addition, the combination of the two treatments was well tolerated and resulted in a further significant decrease in blood pressure compared with monotherapy (p<0.001) and a trend for a further reduction in microalbuminuria. "Combining Atacand and Zestril provides an additional benefit in blood pressure lowering that is clinically relevant, especially in this patient group which is notoriously difficult to treat," said Professor Carl Erik Mogensen, lead investigator of the CALM study, Aarhus University Hospital, Denmark. "Physicians need treatment options able to reach the new blood pressure targets and so reduce the high rates of death and disability in patients with diabetes. Combining these two therapies provides a powerful and well tolerated option which also seems to protect the kidney." Cardiovascular disease is the main cause of death and disability in people with type 2 diabetes in industrialised countries, and they have a two to four times greater risk of coronary heart disease than people who do not have diabetes. Crucially, recent landmark studies such as UKPDS and the HOT study have proven that tight control of blood pressure reduces the risk of death and, macrovascular and microvascular complications in patients with diabetes. The World Health Organisation-International Society of Hypertension (WHO/ISH) guidelines and the American Diabetes Association therefore recommend that the blood pressure of patients with type 2 diabetes should be kept below 130/85 mm Hg, while the International Diabetes Federation recommends a target of 140/85 mm Hg. The HOT study has shown that combination therapy is often needed to reach these low targets. ACE inhibitors, such as Zestril, are widely accepted as the gold standard antihypertensive in patients with diabetes and have been proven to help prevent and reverse renal disease. However, more complete blockade of the renin angiotensin system (RAS) may be needed to meet the new blood pressure targets. ACE inhibitors modulate the RAS at the level of the ACE enzyme (including effect on bradykinin), while Atacand offers more selective blockade at the AT1-receptor and has also demonstrated potential renoprotective properties. "These results provide a powerful argument for dual blockade of the renin angiotensin system. We now know that the addition of Atacand to Zestril is beneficial in diabetes. This provides physicians with a powerful new tool," said Professor Mogensen. CALM was a multi-centre, randomised double-blind study of 199 hypertensive (DBP 90-110 mmHg) type 2 diabetic patients with microalbuminuria. Patients were randomised to either Zestril or Atacand for 12 weeks, followed by an additional 12 weeks of either the same monotherapy or the combination of both agents. After 12 weeks of monotherapy, both Atacand and Zestril significantly reduced sitting blood pressure (Atacand: 12.4/9.5 mmHg p<0.001; Zestril: 15.7/9.7mmHg, p<0.001) and urinary albumin/creatinine ratio (Atacand: - 30 percent p<0.001; Zestril: - 46 percent p<0.001) with no significant differences between treatments. During the second phase of the study there was no further decrease in blood pressure with monotherapy, but the combined treatment resulted in further decrease compared with monotherapy (10.6/6.0mmHg, p<0.001). Both drugs and the combined treatment were well tolerated and no difference in adverse event profile was observed among the three treatment groups. Atacand and Zestril are developed and marketed by AstraZeneca. Atacand is manufactured under licence from Takeda Chemical Industries. AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of ethical (prescription) pharmaceuticals, and the supply of healthcare services. It is one of the top five pharmaceutical companies in the world with sales of $15 billion, and leading positions in sales of cardiovascular, gastrointestinal, oncology, anaesthesia including pain management, central nervous system, and respiratory products. Related Links: Atacand (candesartan cilexetil), Zestril (lisinopril) and AstraZeneca. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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