Angiotensin II type 1 (AT(1)) receptor blockade in hypertensive women: Benefits of candesartan cilexetil versus enalapril or hydrochlorothiazide

The aim of this large, randomized, double-blind, parallel-group study in hy pertensive women was to compare the antihypertensive efficacy and effects o n subjective symptoms and quality of life of the new angiotensin II type 1 (AT(1)) receptor blocker candesartan cilexetil, the angiotensin-converting enzyme inhibitor enalapril, and the diuretic hydrochlorothiazide (HCTZ). Wo men, aged 40 to 69 years, with a seated diastolic blood pressure (DBP) of 9 5 to 115 mm Hg, were randomized to candesartan cilexetil, 8 to 16 mg (n = 1 40), enalapril, 10 to 20 mg (n = 146), or HCTZ, 12.5 to 25 mg (n = 143), fo r 12 weeks; the higher doses were used if DBP was greater than 90 mm Hg aft er 6 weeks. Candesartan cilexetil lowered seated blood pressure by 17/11 an d 19/11 mm Hg after 6 and 12 weeks of treatment, respectively. This reducti on was greater (P < .01) than with enalapril (12/8 and 13/9 mm Hg) or HCTZ (12/7 and 13/8 mm Hg). The proportions of patients with controlled DBP (< 9 0 mm Hg) after 12 weeks of treatment with candesartan cilexetil, enalapril, or HCTZ were 60%, 51% and 43%, respectively. Patients experienced less dry cough (P < 0.001) with candesartan cilexetil or HCTZ than with enalapril. No treatment differences were found in the incidence of dizziness and quali ty of life was well maintained in all groups. Compared with candesartan cil exetil and enalapril, HCTZ increased uric acid and decreased serum potassiu m (P < .001). In conclusion, candesartan cilexetil reduced blood pressure m ore effectively and was better tolerated than enalapril or HCTZ in women wi th mild to moderate hypertension. (C) 2000 American Journal of Hypertension , Ltd.