Clinical studies with candesartan.

Candesartan cilexetil is a new AT(1)-receptor antagonist that has been approved for clinical use in many countries. This article gives a brief summary of the clinical studies that have been performed with candesartan cilexetil. One of the major advantages of candesartan cilexetil is its remarkable tolerability.

The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial.

Background: The prognostic benefits of blood pressure lowering treatment in elderly hypertensive patients were established more than a decade ago, but are less clear in those with mildly to moderately elevated blood pressure.

Objective: To assess whether candesartan-based antihypertensive treatment in elderly patients with mildly to moderately elevated blood pressure confers a reduction in cardiovascular events, cognitive decline and dementia.

Design: Prospective, double-blind, randomized, parallel-group study conducted in 1997-2002.

Hypertension management in 2002: where have we been? where might we be going?

The term "blood pressure" was coined almost 300 years ago by the man who first measured it, the Reverend Stephen Hales of England. However, our understanding of the pathogenesis and consequences of hypertension, as well as the available treatments for it, have remained greatly limited and inadequate until only the past 30 years. Starting in 1977, reports from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension (JNC) have provided regular updates on developments in hypertension management, and have set guidelines for the diagnosis and treatment of hypertension.

How far should we lower blood pressure in the elderly.

In the last few years several large intervention trials have addressed the treatment of hypertension in the elderly and how far blood pressure should be lowered in such patients. The positive results of intervention against high blood pressure in the elderly has resulted in a positive attitude towards treatment and today this is an accepted and highly effective medical intervention. Both stroke and coronary morbidity have been shown to be positively affected as has total mortality.

The relationship between dose and antihypertensive effect for different AT1-receptor blockers.

Hypertensive patients require adequate control of blood pressure to limit the development of cardiovascular complications. The introduction of the angiotensin II type I (AT1)-receptor blockers was an important breakthrough, offering effective control of blood pressure with placebo-like tolerability. The relationship between dose and antihypertensive effect has been more or less well defined for the different AT1-receptor blockers currently available.

Treatment of Hypertension and the J Curve.

The optimal reduction in blood pressure when treating hypertension is obviously the one which reduces hypertension related cardiovascular morbidity and mortality as much as possible. Today's approach to the treatment of high blood pressure usually does not achieve this goal. In other words, treated hypertensive patients are still at increased risk of cardiovascular complications, such as strokes and myocardial infarcts, in spite of being treated with antihypertensive drugs.

Renal function and intensive lowering of blood pressure in hypertensive participants of the hypertension optimal treatment (HOT) study.

This article reports further analyses of the Hypertension Optimal Treatment (HOT) Study data with the aim to describe (1) the value of baseline serum creatinine and its clearance (estimated by Cockroft and Gault formula) as predictors of cardiovascular events, (2) the effects of intensive lowering of BP on cardiovascular events and renal function in patients with reduced renal function, and (3) the effects on cardiovascular events of adding acetylsalicylic acid to antihypertensive therapy in patients with reduced renal function. The results show that (1) baseline elevation in serum creatinine and a reduction in estimated creatinine clearance are powerful predictors of cardiovascular events and death. (2) Reduced renal function at baseline did not preclude the desired control of BP.

Antihypertensive treatment: does the J-curve exist?

In the treatment of arterial hypertension, the optimal reduction in blood pressure is obviously the one that causes the maximum achievable prevention of hypertension-associated cardiovascular morbidity and mortality. This goal has clearly not been reached by today's approach to the treatment of elevated blood pressure. Treated hypertensive patients are still at increased risk of cardiovascular morbidity and mortality in spite of receiving antihypertensive treatment, as shown in many intervention studies.

Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics.

The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multi-centre, prospective, randomized, double-blind, parallel-group study. The primary objective of SCOPE is to assess the effect of the angiotensin II type 1 (AT1) receptor blocker, candesartan cilexetil 8-16 mg once daily, on major cardiovascular events in elderly patients (70-89 years of age) with mild hypertension (DBP 90-99 and/or SBP 160-179 mmHg). The secondary objectives of the study are to test the hypothesis that antihypertensive therapy can prevent cognitive decline (as measured by the Mini Mental State Examination, MMSE) and dementia, and to assess the effect of therapy on total mortality, myocardial infarction (MI), stroke, renal function, and hospitalization.

Headache in mild-to-moderate hypertension and its reduction by irbesartan therapy.

Background: Although it is generally acknowledged to be a problem in severe hypertension, headache has not been consistently associated with mild-to-moderate hypertension.

Patients And Methods: In 7 randomized, double-blind, placebo-controlled trials, which included 2,673 patients with mild-to-moderate hypertension (defined as seated diastolic blood pressure of 95-110 mm Hg), patients were randomized to receive once-daily treatment with irbesartan, an angiotensin II receptor blocker (n= 1,987), or placebo (n=686). The data were pooled and analyzed retrospectively to determine whether the level of hypertension was associated with headache and whether antihypertensive therapy reduced the incidence of headache.

Study on COgnition and Prognosis in the Elderly (SCOPE): Design and Objectives.

Hypertension is a major risk factor for cardiovascular events, including stroke, as well as for white matter lesions of the brain. There is also evidence to link cognitive impairment and dementia to hypertension. However, it has not been established whether antihypertensive treatment of elderly patients with a diastolic blood pressure (DBP) in the range 90-99 mmHg provides protection against major cardiovascular events and cognitive impairment.

Results of the STOP-Hypertension-2 Trial.

The second Swedish Trial in Old patients with Hypertension (STOP-Hypertension-2) was conducted to compare the effects of 'newer( antihypertensive therapies (angiotensin converting enzyme [ACE] inhibitors and calcium antagonists) and established therapies (beta-blockers and diuretics) on cardiovascular mortality and morbidity in elderly hypertensive patients. A total of 6614 patients were randomized to receive conventional treatment, ACE inhibitors or calcium antagonists, and followed for a mean of 5 years. The primary endpoint was a combination of fatal stroke, fatal myocardial infarction and other fatal cardiovascular disease; secondary endpoints were a combination of fatal or non-fatal stroke or myocardial infarction, and other cardiovascular mortality.

The Hypertension Optimal Treatment study and the importance of lowering blood pressure.

Objectives: The Hypertension Optimal Treatment (HOT) Study had two objectives: (1) to define the optimal target blood pressure when treating hypertensive patients (i.e. the level of blood pressure associated with the lowest incidence of major cardiovascular events such as fatal and non-fatal stroke and myocardial infarction and other cardiovascular mortality); and (2) to assess the effect of a low dose of acetylsalicylic acid (aspirin) compared with placebo on major cardiovascular events.

Therapy of hypertension and metabolic syndrome: today's standard and tomorrow's perspectives.

Treatment of arterial hypertension is known to reduce cardiovascular morbidity and mortality and has a positive effect against stroke, where benefit is strongly linked to reduction in blood pressure per se. The protective effects against coronary heart disease (CHD) have also been significant but numerically less impressive than the effect against stroke. It is conceivable that this due to the fact that not just blood pressure, but also a number of metabolic variables need to be considered in this context.

Morbidity and mortality with dihydropyridines.

Calcium antagonists (CaAs) of the dihydropyridine type are widely used in the treatment of hypertension and other cardiovascular disorders. They are markedly effective in lowering elevated arterial pressure, and are well tolerated. Data from long-term intervention trials are emerging, which also show a beneficial effect on cardiovascular morbidity with the use of CaAs in the treatment of hypertension.

Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group.

Background: Despite treatment, there is often a higher incidence of cardiovascular complications in patients with hypertension than in normotensive individuals. Inadequate reduction of their blood pressure is a likely cause, but the optimum target blood pressure is not known. The impact of acetylsalicylic acid (aspirin) has never been investigated in patients with hypertension.

The antiatherosclerotic effect of calcium antagonists in man--what did MIDAS actually show? Multicenter Isradipine Diuretic Atherosclerosis Study.

The Multicenter Isradipine Diuretic Atherosclerosis (MIDAS) Study was a comparison between the dihydropyridine-derived calcium antagonist isradipine and hydrochlorothiazide in 883 hypertensive patients. B-mode ultrasonography of the carotid artery was used in order to evaluate changes in wall thickness and the development of atherosclerotic plaques during a 3-year period. The final publication has yet to appear in a medical journal.

Review of studies with urapidil in elderly hypertensives.

Urapidil, an antihypertensive agent with dual action (alpha 1-adrenergic antagonist and 5HT1A agonist) is well established in the treatment of arterial hypertension. The present brief review deals specifically with data obtained with urapidil in the treatment of elderly hypertensive patients. Some of these data, dealing with 245 patients aged > or = 65 years, have previously been published, but additional data from more than 5000 hypertensive patients in this age group on file will be reviewed as well.