Candesartan cilexetil, a new generation angiotensin II antagonist, provides dose dependent antihypertensive effect

Candesartan is a new generation angiotensin II type 1 receptor blocker, characterised by tight binding to and slow dissociation from the receptor. In order to delineate the dose-response curve for candesartan cilexetil (the orally administered prodrug), results from six European placebo-controlled, dose-response studies were pooled. These were of a double-blind, randomised, parallel group design, with a treatment duration of 4-12 weeks. A total of 1482 patients with mild to moderate primary hypertension were treated with candesartan cilexetil 2 mg (n = 80), 4 mg (n = 216), 8 mg (n = 455) or 16 mg (n = 294), or with placebo (n = 437). Blood pressure (BP) measurements were performed 24 h after dose. The differences in BP change (baseline vs end of the studies) between the placebo group and the groups treated with candesartan cilexetil were assessed using analysis of covariance and dose response curves were estimated by fitting the data to an Emax model. The placebo-corrected mean reductions in sitting diastolic BP were approximately 2.5 mm Hg with 2 mg, 4.5 mm Hg with 4 mg, 6 mm Hg with 8 mg, and 8 mm Hg with 16 mg of candesartan cilexetil. For sitting systolic BP, the placebo-corrected mean reductions were in the order of 5, 7, 10 and 12 mmHg, respectively, with 2, 4, 8 and 16 mg of candesartan cilexetil. The BP reductions were similar in the standing position with no indication of postural hypotension. Age or gender did not influence the BP response to candesartan cilexetil. In conclusion, candesartan cilexetil provides a clinically significant, dose-dependent antihypertensive effect in doses ranging from 4-16 mg once daily.