Candesartan and amlodipine equally suppressed the incidence of cardiovascular events in high-risk hypertensive patients (HR 1.01; 95% CI 0.79-1.28; p=0.969).
RCT (n=4,728)
Open-label, blinded endpoint assessment
Parallel-group
Yes
Does a candesartan-based regimen reduce cardiovascular events compared to an amlodipine-based regimen in high-risk Japanese hypertensive patients?
Candesartan and amlodipine are equally effective in preventing cardiovascular events in high-risk hypertensive patients, though candesartan may offer advantages in reducing left ventricular hypertrophy and new-onset diabetes.
Effect estimate: HR 1.01 (95% CI 0.79-1.28)
p-value: p=0.969
The Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial was a comparative study of the angiotensin II receptor blocker (ARB), candesartan, and a calcium channel blocker (CCB), amlodipine, regarding the incidence of cardiovascular events in high-risk Japanese hypertensive patients. The study design was a prospective, multicenter, randomized, open-label, active-controlled, two-arm, parallel-group comparison study with a response-dependent dose titration and blinded assessment of the end point. The CASE-J trial enrolled 4728 patients, with a mean age of 63.8 years and a mean BMI of 24.6 kg/m(2), who were randomly assigned to either candesartan- or amlodipine-based treatment regimens. Blood pressure was well controlled to the level of less than 140/80 mmHg in both of the treatment regimens. During 3.2 years of follow-up, primary cardiovascular events occurred in 134 patients in each of the two treatment-based regimens, resulting in no significant difference in the incidence of cardiovascular events between them (hazard ratio: 1.01; 95% confidence interval: 0.79-1.28; p = 0.969). In 404 patients with left ventricular hypertrophy, a significantly larger decrease in left ventricular mass index 3 years after enrollment was observed in candesartan-based (n = 205) than amlodipine-based (n = 199) regimens (-22.9 vs -13.4 g/m(2), respectively; p = 0.023). Furthermore, new-onset diabetes occurred in fewer patients taking candesartan than in those taking amlodipine, resulting in a 36% relative risk reduction (p = 0.030). The CASE-J trial demonstrated that both an ARB, candesartan, and a CCB, amlodipine, equally suppressed the incidence of cardiovascular events. The ARB may confer more beneficial effects to hypertensive patients with left ventricular hypertrophy or for those at-risk of diabetes than CCB.
Ogihara et al. (Wed,) conducted a rct in Hypertension (n=4,728). Candesartan vs. Amlodipine was evaluated on Cardiovascular events (HR 1.01, 95% CI 0.79-1.28, p=0.969). Candesartan and amlodipine equally suppressed the incidence of cardiovascular events in high-risk hypertensive patients (HR 1.01; 95% CI 0.79-1.28; p=0.969).
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