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ARB candesartan and CCB amlodipine in hypertensive patients: the CASE-J trial

Toshio Ogihara1, Akira Fujimoto, Kazuwa Nakao

  • 1Osaka General Medical Center, Osaka, Japan.

Expert Review of Cardiovascular Therapy
|October 23, 2008
PubMed

Insights

The Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial found no significant difference in cardiovascular events between candesartan (angiotensin II receptor blocker) and amlodipine (calcium channel blocker). However, candesartan showed benefits for left ventricular hypertrophy and reduced new-onset diabetes risk.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Hypertension Research

Background:

  • High-risk Japanese hypertensive patients require effective treatments to prevent cardiovascular events.
  • Angiotensin II receptor blockers (ARBs) and calcium channel blockers (CCBs) are common antihypertensive drug classes.
  • Comparative data on long-term cardiovascular outcomes between ARBs and CCBs in Japanese populations are limited.

Purpose of the Study:

  • To compare the incidence of cardiovascular events between candesartan (ARB) and amlodipine (CCB) in high-risk Japanese hypertensive patients.
  • To evaluate the effects of candesartan versus amlodipine on left ventricular hypertrophy and new-onset diabetes.

Main Methods:

  • Prospective, multicenter, randomized, open-label, active-controlled trial (CASE-J) involving 4728 high-risk Japanese hypertensive patients.
  • Patients were assigned to either candesartan- or amlodipine-based treatment regimens with response-dependent dose titration.
  • Blinded assessment of endpoints over a mean follow-up of 3.2 years.

Main Results:

  • No significant difference in the primary incidence of cardiovascular events between candesartan and amlodipine groups (HR: 1.01, p=0.969).
  • Candesartan group showed a significantly greater reduction in left ventricular mass index compared to amlodipine in patients with left ventricular hypertrophy (p=0.023).
  • Fewer patients in the candesartan group developed new-onset diabetes compared to the amlodipine group (36% relative risk reduction, p=0.030).

Conclusions:

  • Both candesartan (ARB) and amlodipine (CCB) are equally effective in suppressing the incidence of cardiovascular events in high-risk Japanese hypertensive patients.
  • Candesartan may offer additional benefits over amlodipine in reducing left ventricular mass and the risk of developing new-onset diabetes.
  • ARB-based therapy could be a preferred option for hypertensive patients with left ventricular hypertrophy or at risk for diabetes.

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