Feasibility of regression of hypertension using contemporary antihypertensive agents.

Abstract

BACKGROUND:

Recently, we reported that transient treatment of genetically hypertensive rats with high-dose angiotensin receptor blocker (ARB) causes regression of established hypertension. In this study, we investigated whether treatment with candesartan or nifedipine controlled-release (CR) resulted in a sustained regression of hypertension in humans.

METHODS:

Patients aged 30 to 59 years with untreated stage 1 essential hypertension and a family history of hypertension were treated with the antihypertensive agents candesartan (n = 124) or nifedipine CR (n = 120). After 1 year of treatment (phase 1), the medications were tapered and discontinued (phase 2). During phase 2, home and office blood pressures were monitored for another year to assess posttreatment reoccurrence of stage 1 hypertension.

RESULTS:

In phase 1, after 1 year of treatment a similarly substantial BP decrease was seen in the candesartan (-24.5/16.1 mm Hg) and nifedipine (-26.8/18.0 mm Hg) groups. In phase 2 there was a substantial reoccurrence of hypertension; at the study end, only 1 patient was able to continue without antihypertensive medication. However, a Kaplan-Meier analysis revealed a significant delay of reoccurrence of hyper tension (P = 0.0001) in the candesartan group.

CONCLUSIONS:

One year of treatment with candesartan or nifedipine CR was not associated with marked regression of hypertension in humans at the standard doses used in this trial. However, withdrawal of candesartan was associated with a slightly longer delay before restarting medications. Further studies with larger doses of candesartan given over a longer time are required to determine whether such a regimen may induce sustainable and clinically relevant reversal of hypertension and alteration in its natural history.

• Authors: Hiroyuki Sasamura, Hideaki Nakaya, Stevo Julius, Naoki Tomotsugu, Yuji Sato, Fumiaki Takahashi, Masahiro Takeuchi, Marohito Murakami, Munekazu Ryuzaki, Hiroshi Itoh, STAR CAST investigators
• Journal: American journal of hypertension (Am J Hypertens) Vol. 26 Issue 12 Pg. 1381-8 (Dec 2013) ISSN: 1941-7225 [Electronic] United States
• PMID: 24190927 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Benzimidazoles
• Biphenyl Compounds
• Tetrazoles
• Nifedipine
• candesartan

Topics

• Adult
• Antihypertensive Agents (administration & dosage, therapeutic use)
• Benzimidazoles (administration & dosage, therapeutic use)
• Biphenyl Compounds
• Blood Pressure (drug effects)
• Blood Pressure Determination
• Double-Blind Method
• Drug Administration Schedule
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Hypertension (diet therapy, drug therapy, physiopathology)
• Japan
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Nifedipine (administration & dosage, therapeutic use)
• Prospective Studies
• Tetrazoles (administration & dosage, therapeutic use)
• Treatment Outcome