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Feasibility of treating prehypertension with an angiotensin-receptor blocker
Stevo Julius1, Shawna D Nesbitt, Brent M Egan
1University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI 48106, USA. sjulius@umich.edu
Insights
Treating prehypertension with candesartan significantly reduced the risk of developing stage 1 hypertension over four years. This intervention appears safe and effective for managing elevated blood pressure precursors.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Prehypertension is a precursor to stage 1 hypertension and a significant cardiovascular risk factor.
- Investigating pharmacologic interventions for prehypertension is crucial for preventing hypertension progression.
Purpose of the Study:
- To determine if pharmacologic treatment of prehypertension can prevent or delay the onset of stage 1 hypertension.
- To assess the safety and efficacy of candesartan in managing prehypertension.
Main Methods:
- A randomized controlled trial involving participants with prehypertension.
- Two years of candesartan treatment or placebo, followed by two years of placebo for all participants.
- Lifestyle modification advice was provided to all participants.
Main Results:
- Hypertension developed in 154/400 placebo participants vs. 53/409 candesartan participants within two years (66.3% risk reduction).
- Over four years, hypertension developed in 240/400 placebo participants vs. 208/409 candesartan participants (15.6% risk reduction).
- Serious adverse events were infrequent and comparable between groups (3.5% candesartan vs. 5.9% placebo).
Conclusions:
- Candesartan treatment for prehypertension is well-tolerated and reduces the incidence of stage 1 hypertension.
- Pharmacologic intervention for prehypertension is a feasible strategy to prevent cardiovascular events.
- Nearly two-thirds of untreated prehypertension patients progressed to stage 1 hypertension over four years.
Background:
Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk. We investigated whether pharmacologic treatment of prehypertension prevents or postpones stage 1 hypertension.
Methods:
Participants with repeated measurements of systolic pressure of 130 to 139 mm Hg and diastolic pressure of 89 mm Hg or lower, or systolic pressure of 139 mm Hg or lower and diastolic pressure of 85 to 89 mm Hg, were randomly assigned to receive two years of candesartan (Atacand, AstraZeneca) or placebo, followed by two years of placebo for all. When a participant reached the study end point of stage 1 hypertension, treatment with antihypertensive agents was initiated. Both the candesartan group and the placebo group were instructed to make changes in lifestyle to reduce blood pressure throughout the trial.
Results:
A total of 409 participants were randomly assigned to candesartan, and 400 to placebo. Data on 772 participants (391 in the candesartan group and 381 in the placebo group; mean age, 48.5 years; 59.6 percent men) were available for analysis. During the first two years, hypertension developed in 154 participants in the placebo group and 53 of those in the candesartan group (relative risk reduction, 66.3 percent; P<0.001). After four years, hypertension had developed in 240 participants in the placebo group and 208 of those in the candesartan group (relative risk reduction, 15.6 percent; P<0.007). Serious adverse events occurred in 3.5 percent of the participants assigned to candesartan and 5.9 percent of those receiving placebo.
Conclusions:
Over a period of four years, stage 1 hypertension developed in nearly two thirds of patients with untreated prehypertension (the placebo group). Treatment of prehypertension with candesartan appeared to be well tolerated and reduced the risk of incident hypertension during the study period. Thus, treatment of prehypertension appears to be feasible. (ClinicalTrials.gov number, NCT00227318.).
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