Key result
Candesartan-based therapy reduces MACE ~21% vs. non-ARB regimens in hypertensive CAD with renal impairment.
Why the study?
The effects of angiotensin receptor blocker-based therapy on cardiovascular events in high-risk hypertensive patients with CAD and impaired renal function were unclear.
Does candesartan-based therapy reduce major adverse cardiac events in hypertensive patients with coronary artery disease and impaired renal function?
RCT (n=2,049)
randomly assigned
Does candesartan-based therapy reduce major adverse cardiac events in hypertensive patients with coronary artery disease and impaired renal function?
In a post hoc analysis, candesartan-based therapy significantly reduced the risk of major adverse cardiac events, driven by reduced hospitalization for unstable angina, in hypertensive patients with CAD and impaired renal function.
The aim of this study was to assess the effects of angiotensin receptor blocker (ARB)-based therapy on cardiovascular events in high-risk hypertensive patients with coronary artery disease (CAD) and impaired renal function in post hoc analysis of HIJ-CREATE (Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease). Patients (n=2049) were randomly assigned to candesartan-based or non-ARB treatment arms; 1022 patients (age 70 ± 6 years, 28% female) with impaired renal function, defined as creatinine clearance <60 ml/min at baseline. There was no difference in major adverse cardiac event (MACE), a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke and other cardiovascular events requiring hospitalization between the two arms in patients without impaired renal function. However, there was a lower incidence of MACE in the candesartan-based treatment arm than in the non-ARB treatment arm (HR=0.79, 95% CI 0.63-0.99, p=0.039) in patients with impaired renal function. Among the MACE, candesartan-based treatment reduced hospitalization for unstable angina (HR=0.71, 95% CI 0.52-0.96, p=0.028). Although candesartan-based treatment was not superior to non-ARB treatment in prevention of cardiac mortality, ARB-based therapy may be beneficial in reducing risk of coronary events in hypertensive patients with CAD and impaired renal function.
No takes yet. Share an insight, caveat, or question.
Shiga et al. (2010) conducted an RCT in Hypertension with coronary artery disease and impaired renal function (n=2,049). Candesartan-based therapy vs. Non-ARB treatment was evaluated on Major adverse cardiac event (MACE), a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke and other cardiovascular events requiring hospitalization (HR 0.79, 95% CI 0.63-0.99, p=0.039). Candesartan-based therapy reduced major adverse cardiac events compared to non-ARB treatment in hypertensive patients with CAD and impaired renal function (HR 0.79; 95% CI 0.63-0.99; p=0.039).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: