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Prehypertension: a possible target for antihypertensive medication
1Division of Hypertension, University of Michigan Medical Center, 3918 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0356, USA. snesbitt@umich.edu
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Investigating early blood pressure lowering with an angiotensin receptor blocker may prevent hypertension. This approach could reduce long-term cardiovascular and renal disease incidence, offering a novel prevention strategy.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Elevated blood pressure and associated vascular changes can precede hypertension diagnosis.
- Hypertension complications like coronary heart and renal disease progress despite treatment.
- Current non-pharmacologic hypertension prevention methods face compliance challenges.
Purpose of the Study:
- To investigate the efficacy of early intervention with an angiotensin receptor blocker in preventing hypertension.
- To assess the long-term impact of blood pressure lowering on hypertension incidence and its consequences.
Main Methods:
- A 2-year randomized controlled trial comparing candesartan cilexitil (angiotensin receptor blocker) with placebo in patients with high-normal blood pressure.
- A subsequent 2-year follow-up period to monitor hypertension incidence after treatment discontinuation.
- Enrollment of 1000 patients, with study completion anticipated in 2004.
Main Results:
- Data on hypertension incidence post-treatment and placebo comparison are pending study completion.
- Analysis will focus on the preventative effect of candesartan cilexitil on developing clinical hypertension.
- Long-term consequences of hypertension in both groups will be evaluated.
Conclusions:
- Early pharmacological intervention, specifically renin-angiotensin system blockade, shows promise in preventing hypertension.
- Novel strategies are needed to overcome limitations of current non-pharmacologic hypertension prevention.
- Successful prevention could significantly reduce the global burden of hypertension and its associated diseases.
Abstract:
Vascular changes associated with elevated blood pressure may precede the clinical diagnosis of hypertension. Even after the diagnosis is made, associated coronary heart disease and renal disease continue to progress, despite adequate blood pressure control. Early treatment of blood pressure may reduce the incidence of clinical hypertension and reduce the long-term consequences of hypertension. Animal studies have shown that early blood pressure lowering, through blockade of the renin-angiotensin system, prevents long-term hypertension. Prevention is an important goal in the treatment of hypertension. Our best attempts to prevent hypertension use nonpharmacologic methods of diet and exercise. These methods are fraught with difficulties of implementation and compliance that limit their success. Finding novel approaches to prevent hypertension may have a major impact on the incidence of hypertension. We are investigating the effect of 2 years of treatment with an angiotensin receptor blocker (candesartan cilexitil) compared with placebo, followed by 2 years of follow-up, on the incidence of hypertension in patients with high-normal blood pressure. Incidence of hypertension after discontinuation of active treatment will be compared with the incidence in the placebo group. There will be 1000 patients enrolled in the study, which will be completed in 2004.