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Candesartan better than amlodipine in hypertension

By Lilian Anekwe

Candesartan has a greater effect on reducing the risk of new-onset diabetes in patients with hypertension compared with amlodipine, but the calcium channel blocker may have the greater effect in obese patients, a study has found.

The Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial found similar rates of cardiovascular disease in 4,703 hypertensive patients randomised to either candesartan or amlodipine. But patients on candesartan were 35% less likely to develop new-onset diabetes compared with those taking amlodipine.

But BMI had a significant effect on efficacy of the drugs. In patients with a BMI of at least 27.5kg/m2, the risk for death from any cause was significantly greater – at 32% - in patients on amlodipine compared to those given candesartan. The increase in new-onset diabetes was dependent on BMI for amlodipine but not for candesartan.

Study leader Dr Kazua Nakao, a researcher in evidence-based medicine at Kyoto University School of Medicine, concluded: ‘Candesartan treatment may produce significant suppression of all-cause death and reduce new-onset diabetes mellitus in patients with obesity. Results from this analysis will likely be of long-term benefit to obese hypertensive patients.'

Hypertens Res published online 13 April 2010

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