NEW YORK (Reuters Health) – Rates of major adverse cardiovascular events (MACEs) are lower in hypertensive patients with coronary artery disease on amlodipine when candesartan is added to their treatment, a Japanese trial shows.

Dr. Junichi Yamaguchi and colleagues with The Heart Institute of Japan, Tokyo Women’s Medical University, are conducting a randomized trial of candesartan in 2049 patients with hypertension and angiographically documented CAD. A subgroup of 388 patients were on amlopidine at baseline; 170 of them were assigned to candesartan, while the other 218 were assigned to non-ARB standard therapy.

During 4.3 years of followup, MACEs — such as cardiovascular death, nonfatal MI, unstable angina, heart failure, or stroke — occurred in 37 patients (21.8%) in the amlodipine and candesartan group and 70 patients (32.1%) in the amlodipine and non-ARB group, Dr. Yamaguchi and colleagues report in the American Journal of Cardiology online August 2nd.

The MACE hazard ratio with the addition of candesartan versus without was 0.61 (p=0.015)

“The most frequent component of the primary end point, unstable angina pectoris requiring hospitalization, was reduced in the amlodipine and candesartan group from 21.6% to 11.2% (hazard ratio 0.48, p=0.007),” the investigators found.

They also point out that many of the control subjects were taking an ACE inhibitor, so the findings can be considered as indicating the difference between the combination of amlodipine and an ARB and amlodipine and ACE inhibitors.

However, whether the effects are a class effect of ARBs or specific to candesartan, they cannot say.

Reference:

Effect of Amlodipine + Candesartan on Cardiovascular Events in Hypertensive Patients With Coronary Artery Disease (from The Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease [HIJ-CREATE] Study)


Am J Cardiol 2010;