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Candesartan improves maximal exercise capacity in hypertensives: results of a randomized placebo-controlled crossover

Maria Leonarda De Rosa1, Massimo Chiariello

  • 1Department of Internal Medicine, Cardiology Unit, Faculty of Medicine, University of Naples "Federico II" DD, Via Caravaggio, Naples, Italy. marialeonarda.derosa@unina.it

Journal of Clinical Hypertension (Greenwich, Conn.)
|July 21, 2009
PubMed

Insights

Hypertension and cardiac hypertrophy impair exercise capacity. Angiotensin receptor blocker candesartan improved peak oxygen volume (VO2) and exercise tolerance in patients with hypertension and left ventricular hypertrophy.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Exercise Physiology

Background:

  • Cardiac hypertrophy and remodelling in hypertension are linked to reduced exercise capacity.
  • Hypertensive patients with left ventricular hypertrophy often exhibit impaired maximal workload achievement.

Purpose of the Study:

  • To evaluate the effect of candesartan, an angiotensin receptor blocker, on exercise peak oxygen volume (VO2) in patients with hypertension and left ventricular hypertrophy.
  • To determine if candesartan improves exercise tolerance in this patient population.

Main Methods:

  • 154 untreated hypertensive patients (WHO stage I/II, with left ventricular hypertrophy) were randomized to placebo or candesartan (32 mg), with or without aspirin (300 mg/d), for 3-week treatment periods and 3-week washout.
  • Measurements included maximal workload, oxygen reserve via exercise testing, 24-hour ambulatory blood pressure, and echocardiography.

Main Results:

  • Hypertensive patients showed impaired maximal workload compared to controls (P=.01).
  • Impaired exercise capacity correlated with lower oxygen reserve (r=0.49, P<.001), which was associated with greater left ventricular hypertrophy (beta=-0.34).
  • Candesartan, alone or with aspirin, significantly improved peak VO2 and exercise tolerance compared to placebo.

Conclusions:

  • Patients with hypertension and cardiac hypertrophy have reduced maximal exercise capacity.
  • Angiotensin receptor blockers like candesartan may be beneficial in improving exercise peak VO2 and tolerance in these patients.
  • Aspirin did not demonstrate a significant impact on the measured outcomes.

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