Key result
A 12-month treatment with candesartan reduced afferent arteriolar resistance by 14% (P<0.01) but did not prevent long-term blood pressure increases over 10 years compared with placebo.
Why the study?
Does 12 months of candesartan reduce afferent arteriolar resistance and prevent long-term blood pressure increase in young adults genetically predisposed to essential hypertension?
RCT (n=110)
Does 12 months of candesartan reduce afferent arteriolar resistance and prevent long-term blood pressure increase in young adults genetically predisposed to essential hypertension?
Short-term inhibition of the renin-angiotensin system with candesartan does not prevent long-term blood pressure increases in young adults genetically predisposed to hypertension.
AIM: Young individuals genetically predisposed for essential hypertension have increased renal vascular resistance. We evaluated whether 1 year of angiotensin II receptor blockade decreases afferent arteriolar resistance (RA) and induces a sustained blood pressure (BP) reduction during a 10-year follow-up period in offspring of parents both diagnosed with essential hypertension. METHODS: Based on renal plasma flow (p-aminohippurate clearance) and glomerular filtration rate (Cr-EDTA clearance) RA was calculated according to the model originally established by Gomez. Following baseline measurements, the participants (n = 110, mean age 30 years) were randomly allocated to 12 months of treatment with either candesartan or placebo followed by repetition of measurements and withdrawal of medication. Four-hour ambulatory BP (ABP) was recorded at baseline, by end of active treatment and after 6 months, 1, 2, 3, 5, and 10 years. ABP was analyzed according to RA achieved at the end of active treatment. RESULTS: Candesartan reduced RA by 14% (P < 0.01). Ten years posttreatment systolic ABP increased by 2.1 mmHg (P = 0.04) and diastolic by 4.2 mmHg (P < 0.01) compared with baseline, without any difference between treatment arms. A high posttreatment RA was associated with higher BP levels during follow-up, but long-term alterations in 24-h BP were similar in participants with low and high RA and not different between treatment arms. CONCLUSION: RA is associated with 24-h BP levels, but temporary lowering of BP and RA by candesartan does not prevent BP from increasing further. Prevention of hypertension appears not feasible by short-term inhibition of the rennin-angiotensin system in young adults.
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Buus et al. (2016) conducted an RCT in Genetic predisposition for essential hypertension (n=110). Candesartan vs. Placebo was evaluated on Afferent arteriolar resistance (RA) and sustained blood pressure reduction. A 12-month treatment with candesartan reduced afferent arteriolar resistance by 14% (P<0.01) but did not prevent long-term blood pressure increases over 10 years compared with placebo.
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