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my personal edition > hypertension > news
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DGDispatch
Candesartan Improves Outcomes in Diabetes, Kidney Patients: Presented at AHA
By Ed Susman
ORLANDO, FL -- November 8, 2007 -- Researchers said they observed benefits in preventing diabetes in patients with chronic kidney disease in a study in which the angiotensin-receptor blocker candesartan was pitted against standard high-blood-pressure treatment in patients with proven cardiovascular disease.
However, doctors said that the antihypertensive was not overall better than standard therapy in significantly reducing cardiovascular events.
"In comparison with standard therapy, candesartan-based therapy reduced by 11% the risk of major adverse cardiovascular events," said Hiroshi Kasanuki, MD, Professor of Internal Medicine, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
"However, that was not statistically significant," Dr. Kasanuki said at the American Heart Association (AHA) 2007 Scientific Sessions.
On the other hand, Dr. Kasanuki said that new onset diabetes occurred in just 1.1% of the 1,024 patents on candesartan compared with 2.9% of the patients treated with other blood-pressure-lowering medications that did not include angiotensin-receptor blockers.
"We observed that treatment with candesartan reduced that risk by 63% (P =.027)," he said during a press briefing. He also noted that patients on candesartan had fewer adverse events than the 1,025 patients who received standard therapy.
"Treatment with candesartan reduced by 21% the risk of major adverse cardiovascular events in patients who entered the trial with impaired renal function (P =.039)," Dr. Kasanuki said.
He reported the results of the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease (HIJ-CREATE), a study which sought to determine whether the newer angiotensin-2-receptor blockers such as candesartan were better than standard therapy that might include angiotensin-converting enzyme (ACE) inhibitors, known to improve clinical outcomes in patients with coronary artery disease.
The randomized, prospective, open-label, blinded-endpoint study was conducted at 14 medical centers in Japan. The primary endpoint was a major cardiovascular event, including cardiovascular death, myocardial infarction, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization. Secondary endpoints included the incidence of revascularization and new-onset diabetes.
Patients were eligible for the study if they had angiographically documented coronary artery disease and had high blood pressure, defined as systolic blood pressure equal to or greater than 140 mm Hg and diastolic blood pressure equal to or greater than 90 mm Hg, or were currently taking antihypertensive medication. About 35% of the patients had acute coronary syndromes and about 65% had stable coronary artery disease. The patients had preserved left ventricular ejection fraction. Patients were followed for 5 years.
Support for this study was provided by Japan Research Promotion Society for Cardiovascular Diseases.
[Presentation title: Randomized Trial of ARB-based Versus Non-ARB Standard Therapy in Patients With CAD and Hypertension. Late Breaking Clinical Trial]
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