Comparison of angiotensin II receptor blockers: Impact of missed doses of candesartan cilexetil and losartan in systemic hypertension

Blood pressure remains poorly controlled in the hypertensive population due in large part to low or unsatisfactory patient compliance. Clinical studie s that incorporate an intentionally missed dose have been designed to evalu ate the impact of poor patient compliance on the effectiveness of antihyper tensive medications. In these studies, ambulatory blood pressure monitoring is continued throughout the dosing interval and beyond in order to determi ne when systolic and diastolic blood pressure increase into the hypertensiv e range. In an 8-week, randomized, double-blind, placebo-controlled trial i n patients with mild-to-moderate hypertension, the antihypertensive effects of candesartan cilexetil 16 mg were maintained after a missed dose, wherea s systolic and diastolic blood pressure increased toward baseline levels af ter a missed dose of losartan 100 mg. Candesartan cilexetil provided a sign ificantly greater reduction in sitting systolic (p = 0.004) and diastolic b lood pressure (p = 0.008) than losartan when measured 48 hours after the la st dose. Moreover, the hamogeneity of antihypertensive effects was greater after candesartan cilexetil than losartan based on calculation of the smoot hness index from ambulatory systolic and diastolic measurements during the first 24-hour period after dosing and during the 12-hour period after the m issed dose. These results demonstrate that missing or delaying a dose of ca ndesartan cilexetil has less impact on antihypertensive efficacy than missi ng or delaying a dose of losartan. (C) 1999 by Excerpta Medica, Inc.