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Ramipril Combined With Candesartan Plus ACE Inhibitor Shows Synergistic Improvements to Hypertensive Patients: Presented at AHA

By Ed Susman

CHICAGO, IL -- November 17, 2006 -- Combining the angiotensin converting enzyme inhibitor ramipril with the angiotensin receptor blocker candesartan gives patients wider protection against harmful cytokines than does treatment with either drug alone, researchers said here at the American Heart Association (AHA) 2006 Scientific Sessions.

"Ramipril combined with candesartan improves endothelial function and increases plasma adiponectin and reduces leptin levels to a greater extent than monotherapy with either drug in hypertensive patients," said Kwang Koh, MD, professor of medicine, cardiology division, Gil Heart Center, Incheon, Republic of Korea.

In the study, 34 patients were tested in 3 crossover studies with 2-week washout periods to determine how ramipril alone, candesartan alone, the 2 drugs together or placebo affect certain cytokine parameters. Ramipril was dosed at 10 mg daily; candesartan was dosedat 16 mg daily.

At his poster presentation on November 15^th, Dr. Koh said he investigated using the 2 drugs together because they have different mechanisms. "We hypothesized that combined therapy may have additional beneficial effects to improve endothelial dysfunction and adipocytokine profiles in patients with hypertension," he explained.

His results appeared to prove the point. For example, treatment with ramipril alone decreased leptin levels by 10%, candesartan monotherapy reduced leptin by 5%, but the 2 drugs together reduced leptin levels by 20% (P = .042).

Adiponectin levels were increased by ramipril by 15%, candesartan by 10%, and the combination by 25% (P = .020), Dr. Koh said.

"Thus, combining drugs that target different aspects of the renin angiotensin system may have merit in the treatment of both cardiovascular and metabolic diseases that are characterized by reciprocal relationships between endothelial dysfunction and insulin resistance," he said.


[Presentation title: Ramipril Combined with Candesartan Improves Vascular and Metabolic Responses to a Greater Extent Than Monotherapy in the Treatment of Hypertensive Patients. Abstract 3623]

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