Introducing candesartan 32 mg plus hydrochlorothiazide 25 mg in previously untreated patients with severe essential...

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Severe essential hypertension requires effective treatment strategies.
• Combination therapy is often necessary to achieve blood pressure control.

Purpose of the Study:

• To evaluate the efficacy and safety of a stepped-care approach using candesartan and hydrochlorothiazide (HCTZ) in patients with severe essential hypertension.
• To determine the effectiveness of escalating doses of candesartan and HCTZ in achieving target blood pressure.

Main Methods:

• Prospective, open-label, single-group study involving 106 treatment-naive patients with severe hypertension.
• Patients initiated on candesartan 16 mg, followed by addition of HCTZ 12.5 mg, and finally escalated to candesartan 32 mg/HCTZ 25 mg over 9 weeks.
• Primary endpoint: mean reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP); response defined as SBP <140 mmHg or ≥20 mmHg decrease, and DBP <90 mmHg or ≥10 mmHg decrease.

Main Results:

• Significant reductions in SBP (44.4 ± 16.8 mmHg) and DBP (32.0 ± 11.3 mmHg) were observed (P < 0.0001).
• Overall response rate was 92.4%, with 64.8% of patients achieving blood pressure <140/90 mmHg.
• The target blood pressure of <140/90 mmHg was achieved by over 50% of patients only after the full dose titration of candesartan 32 mg/HCTZ 25 mg.

Conclusions:

• A stepped treatment approach with candesartan/HCTZ combination therapy is effective and safe for rapid blood pressure reduction in newly diagnosed severe hypertension.
• Achieving the target blood pressure of <140/90 mmHg requires the full therapeutic dose of candesartan 32 mg and HCTZ 25 mg in a significant proportion of patients.