Phenotype of a patient with arterial hypertension for therapy with candesartan and its combinations with a diuretic or calcium antagonist

The article provides a review on the efficacy and safety of the use of candesartan in hypertension through the lens of current clinical guidelines, and considers updated data on the efficacy and metabolic effects of different candesartan-based combinations. A clear phenotype of a patient with hypertension who can be selected for the prescription of candesartan has been built-up, and the principles of differentiated approach to prescribing candesartan-based combinations for the treatment of hypertension have been outlined, taking into account metabolic effects and impact on the end points. It has been shown that candesartan is more effective than irbesartan, valsartan and losartan in lowering blood pressure, can reduce the risk of hypertension in people with normal high blood pressure or in young people with familial risks, and has the largest and most diverse evidence in the treatment of chronic heart failure, and significantly reduces the risk of cardiovascular complications as well as restrains the progression rates of diabetic retinopathy. The patient’s phenotype for the candesartan and amlodipine combination suggests that the presence of one or more of the following conditions: metabolic syndrome (particularly with impaired glucose tolerance and hypertriglyceridemia), the need for targeted angioprotection, hyperuricemia, hypokalemia tendency, or the necessity to replace other angiotensin II receptor blockers with candesartan-based combinations. The candesartan and hydrochlorothiazide combination is preferable for HOPE-3-like patients, patients with a history of strokes or transient ischemic attacks, as well as recurrent strokes, the presence of hypervolemia (obesity, perimenopause), the need for treatment or prevention of chronic heart failure, replacement of other angiotensin II receptor blockers with candesartan-based combinations. The prescription of the candesartan and hydrochlorothiazide combination using the 24-hour blood pressure monitoring in a patient requires to exclude the 24-hour night-picker or non-dipper profile and the morning blood pressure surge, as the effect of hydrochlorothiazide does not exceed 12 hours. Both combinations have also been shown to improve cognitive function.