Related Experiment Videos
Effects of candesartan on cardiac and arterial structure and function in hypertensive subjects
J C Spratt1, D J Webb, A Shiels
1University of Edinburgh, UK. jamesspratt@blueyonder.co.uk
Insights
Candesartan treatment significantly reduced left ventricular mass and arterial stiffness in hypertensive patients. The study also showed improvements in left ventricular diastolic function and arterial function, indicating a comprehensive cardiovascular benefit.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Hypertension is a major risk factor for cardiovascular disease, often leading to left ventricular hypertrophy and arterial stiffening.
- Angiotensin II receptor blockers, such as candesartan, are commonly used to manage hypertension.
- Understanding the comprehensive effects of candesartan on cardiac and vascular parameters is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate the impact of candesartan cilexetil on left ventricular mass index (LVMI) and function in hypertensive patients.
- To assess the drug's effects on arterial structure and function, including augmentation index (AIx) and vascular resistance.
- To determine the blood pressure-lowering efficacy of candesartan using both office and ambulatory monitoring.
Main Methods:
- A 24-week study involving 35 hypertensive patients treated with candesartan (16 mg daily), with optional hydrochlorothiazide addition.
- Left ventricular structure and function were assessed via transthoracic echocardiography.
- Arterial function was measured using pulse wave analysis and forearm plethysmography; blood pressure was monitored via office readings and 24-hour ambulatory BP monitoring (ABPM).
Main Results:
- Candesartan treatment resulted in a significant mean reduction in LVMI of 4.4 g/m2 (p=0.022).
- Significant improvements were observed in left ventricular diastolic function, with increased diastolic time and peak filling velocity.
- Arterial stiffness (AIx) and vascular resistance significantly decreased, alongside substantial reductions in both central and peripheral blood pressure.
Conclusions:
- 24-week treatment with candesartan (16 mg daily), with or without hydrochlorothiazide, effectively reduced left ventricular mass and arterial hypertrophy in hypertensive patients.
- The study demonstrated parallel improvements in left ventricular diastolic function and arterial function, highlighting candesartan's multifaceted cardiovascular benefits.
- Candesartan is an effective therapeutic option for improving cardiac remodeling and vascular health in individuals with hypertension.
Objectives:
To study the effect of candesartan cilexetil on left ventricular mass index (LVMI), left ventricular systolic and diastolic function, arterial structure and function and blood pressure (BP) in hypertensive patients.
Design And Methods:
Patients (n=35), aged >20 years, with hypertension and average baseline LVMI of 89 g/m2 were treated for 24 weeks with candesartan, 16 mg o.d., following a four-week placebo run-in period. If diastolic BP remained above 95 mmHg, hydrochlorothiazide, 12.5 mg o.d.,was added. Left ventricular structure and function were assessed using transthoracic echocardiography. Arterial function and structure were assessed using pulse wave analysis to calculate augmentation index (AIx) and forearm plethysmography to calculate minimum vascular resistance. BP was measured in the office and by 24-hour ambulatory BP monitoring (ABPM).
Results:
The mean reduction in LVMI was 4.4 g/m2(p=0.022). Left ventricular systolic function was not significantly altered from baseline, but diastolic function significantly improved: the mean change in diastolic time was 54 ms (p=0.037), in peak velocity filling 6.3 cm/s (p=0.023); E:A ratio improved by 0.08 (p=0.049). The mean reduction in forearm vascular resistance was 15 units at rest (p=0.001) and 1.3 units after limb ischaemia (p=0.006). AIx decreased significantly, with a mean reduction of 9% (p<0.001). Central BP also significantly reduced(systolic blood pressure/diastolic blood pressure 31/20 mmHg; p<0.001). BP was significantly reduced, both in the office (22/16 mmHg; p<0.001) and by 24-hourABPM (18/12 mmHg; p<0.001).
Conclusions:
Treatment with candesartan, 16 mg o.d., with or without hydrochlorothiazide, for 24 weeks, significantly reduced left ventricular mass and arterial hypertrophy in patients with hypertension. In parallel, there were significant improvements in left ventricular diastolic function and arterial function.