Efficacy of candesartan cilexetil alone or in combination with amlodipine and hydrochlorothiazide in moderate-to-severe hypertension

This multicenter study evaluated the efficacy of candesartan cilexetil, an angiotensin II type 1 receptor antagonist, used alone or in combination wit h amlodipine or in combination with amlodipine and hydrochlorothiazide in t he treatment of patients with moderate-to-severe essential hypertension. Af ter a 2-week, single-blind, placebo run-in period, patients entered a 12-we ek, open-label, dose-titration period. The candesartan cilexetil dose was i ncreased from 8 to 16 mg once daily; amlodipine (5 mg once daily), hydrochl orothiazide (25 mg once daily), and additional medication were also added s equentially if necessary. Patients then entered a final 4-week, parallel-gr oup, double-blind, randomized, placebo-controlled withdrawal period of cand esartan alone. A total of 216 patients were recruited. After a 2-week run-i n period on placebo tablets, mean sitting blood pressure (BP) was 175/108 m m Hg. At the end of the 12-week dose-titration/maintenance period, mean sit ting BP fell to 141/88 mm Hg. In 67 patients who were randomized to placebo and had their candesartan withdrawn, there was a highly significant increa se in mean systolic/diastolic BP (13/6 mm Hg) compared with those patients who continued with candesartan (ANCOVA, P<0.0001). In conclusion, candesart an cilexetil is an effective BP-lowering drug when used alone or in combina tion with amlodipine or amlodipine plus hydrochlorothiazide in the treatmen t of moderate-to-severe essential hypertension. The drug was well tolerated throughout the investigation period.