Candesartan cilexetil in hypertension: Effects of six weeks' treatment on haemodynamics, baroreceptor sensitivity and the renin-angiotensin-aldosterone system

The effects of the angiotensin II receptor blocker candesartan cilexetil on systemic and forearm haemodynamics and baroreceptor sensitivity were evalu ated in this randomized, placebo-controlled, double-blind, crossover study. After a 4-week placebo run-in period, 22 patients with essential hypertens ion (diastolic blood pressure 100-114 mmHg) were randomized to receive eith er candesartan cilexetil 16 mg or placebo once daily for 6 weeks. At the en d of each period, 24 h after the last dose, invasive haemodynamic assessmen ts were performed. Simultaneously, the plasma renin activity and plasma con centrations of angiotensin II, aldosterone and catecholamines were measured . Compared to placebo, candesartan cilexetil significantly reduced mean art erial pressure by 8 mmHg (95% CI: 2.6; 12.3), while cardiac output, stroke volume and heart rate were unchanged. Forearm vascular resistance was reduc ed by 1 mmHg*ml(-1) *L*min (CI: 0.3; 2.3). The baroreceptor sensitivity was not influenced, but a change in the set-point was noted. Plasma renin acti vity and angiotensin II concentrations were increased, while the aldosteron e concentration was significantly reduced. Plasma catecholamine concentrati ons were unaffected. In conclusion, 6 weeks' treatment with candesartan cil exetil 16 mg o.d. induced systemic and forearm vasodilatation and a reducti on in blood pressure without compromising cardiac performance. The plasma c oncentration of aldosterone was reduced.