Volume 12, Number 4, July-August 2005

Comparison of two- and three-drug combination therapy with candesartan in patients with severe hypertension
Heinrich Holzgreve, Reinhard Gotzen, Gerhard Kiel

The efficacy and tolerability of two candesartan treatment regimens were evaluated in 578 severely hypertensive patients already receiving a diuretic plus an angiotensin-converting enzyme (ACE) inhibitor, a calcium channel blocker (CCB) or a beta blocker. Existing treatments were standardised during a two-week run-in period. Patients with uncontrolled blood pressure (diastolic blood pressure [DBP] > 90 mmHg) were randomly switched to a regimen comprising candesartan 16 mg plus hydrochlorothiazide (HCT) 12.5 mg once daily for four weeks (switch regimen, n=291), or had candesartan 8 mg once daily added to their existing treatment (add-on regimen, n=287). After four weeks’ treatment, mean sitting DBP was reduced from baseline by 11.2 mmHg (SD 11.2) and 13.9 mmHg (SD 11.5) in the switch and add-on treatment groups, respectively. Mean sitting SBP was decreased by 15.3 mmHg (SD 18.7) and 20.7 mmHg (SD 20.3), respectively. During an additional four weeks’ treatment, ‘switch’ non-responders had their doses of study medications doubled, resulting in a further reduction of 5.4 mmHg (SD 9.8) DBP and 5.9 mmHg (SD 14.9) SBP. Both treatment regimens were well tolerated. Thus, in patients with severe hypertension, adding candesartan to a standard-dose two-drug combination, or switching from a pre-existing two-drug, standard-dose combination to high-dose candesartan plus HCT enables enhanced BP control, with superiority of the three- over the two-drug combination.

Br J Cardiol 2005;12:291-297.

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