Atacand (Candesartan Cilexetil) - Summary

ATACAND SUMMARY

ATACAND (candesartan cilexetil), a prodrug, is hydrolyzed to candesartan during absorption from the gastrointestinal tract. Candesartan is a selective AT₁ subtype angiotensin II receptor antagonist.

ATACAND is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents.

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NEWS HIGHLIGHTS

Media Articles Related to Atacand (Candesartan Cilexetil)

New Consortium Paves The Way For Improved Treatment Of Hypertension And Associated Vascular Complications
Source: Hypertension News From Medical News Today [2009.11.18]
Top Institute Pharma (TI Pharma) has formed a consortium with Actelion Pharmaceuticals Ltd, Erasmus Medical Centre and Maastricht University to define new modalities for the treatment of hypertension (high blood pressure) and associated vascular complications such as heart and kidney failure, myocardial infarction and stroke.

Kids with CKD Often Have Masked Hypertension (CME/CE)
Source: MedPage Today Nephrology [2009.11.13]
Many children with chronic kidney disease may have undetected hypertension, placing them at risk for enlarged hearts and future cardiovascular disease, a cross-sectional study showed.

Key Player Identified In Cascade That Leads To Hypertension-Related Kidney Damage
Source: Hypertension News From Medical News Today [2009.11.06]
A key player in a cascade that likely begins with stress and leads to high blood pressure and kidney damage has been identified by researchers who say the finding may lead to better ways to control both. Medical College of Georgia researchers have found endothelin, a powerful blood vessel constrictor and inflammatory peptide, increases the number of T cells in the kidneys, which helps recruit other immune cells, causing inflammation and destruction.

A Recipe For Hypertension: High Fructose Corn Syrup
Source: Hypertension News From Medical News Today [2009.10.31]
A diet high in fructose increases the risk of developing high blood pressure (hypertension), according to a paper presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, California. The findings suggest that cutting back on processed foods and beverages that contain high fructose corn syrup (HFCS) may help prevent hypertension.

Hypertension Guidelines Reappraised In Light Of New Research
Source: Hypertension News From Medical News Today [2009.10.30]
A Task Force of the European Society of Hypertension have released the official European guidelines on the management and treatment of hypertension. The guidelines are an update of those published in 2007, and will be published in the November issue of the Journal of Hypertension.

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Published Studies Related to Atacand (Candesartan Cilexetil)

Supramaximal dose of candesartan in proteinuric renal disease. [2009.04]
High levels of proteinuria predict renal deterioration, suggesting that interventions to reduce proteinuria may postpone the development of severe renal impairment. This multicenter Canadian trial evaluated whether supramaximal dosages of candesartan would reduce proteinuria to a greater extent than the maximum approved antihypertensive dosage...

Effects of candesartan cilexetil on carotid remodeling in hypertensive diabetic patients: the MITEC study. [2009]
In hypertension and diabetes, early structural changes of the arterial wall precede or support atherosclerosis... The results of this study show that CC and AML treatments may alter identically the natural progression of carotid IMT in hypertensive type 2 diabetic patients.

Combination therapy with candesartan cilexetil 32 mg and hydrochlorothiazide 25 mg provides the full additive antihypertensive effect of the components: A randomized, double-blind, parallel-group study in primary care. [2009]
BACKGROUND AND OBJECTIVE: Fixed-combination tablets of candesartan (orally administered as the pro-drug candesartan cilexetil and hereafter referred to as candesartan) and hydrochlorothiazide (HCTZ) 8/12.5 mg and 16/12.5 mg are effective and well tolerated. However, some patients require higher doses to attain target blood pressure, and combination tablets containing candesartan and HCTZ at the upper end of their respective dose ranges are now being developed. This study aimed to assess the antihypertensive effect and tolerability of the combination of candesartan 32 mg and HCTZ 25 mg versus candesartan 32 mg monotherapy, HCTZ 25 mg monotherapy, and placebo... CONCLUSION: The antihypertensive effect of candesartan/HCTZ 32/25 mg represents fully additive contributions from each of its components, and is generally well tolerated in patients with mild to moderate primary hypertension. This combination adds to the treatment options for improving blood pressure control in patients with hypertension.

Antihypertensive efficacy and tolerability of candesartan-hydrochlorothiazide 32/12.5 mg and 32/25 mg in patients not optimally controlled with candesartan monotherapy. [2008.12]
AIM: To evaluate the efficacy and tolerability of candesartan cilexetil 32 mg in combination with hydrochlorothiazide (HCT) 12.5 mg or 25 mg in hypertensive patients not optimally controlled with candesartan monotherapy... CONCLUSION: Candesartan-HCT 32/12.5 mg and candesartan-HCT 32/25 mg are highly effective and provide improved blood pressure reduction and blood pressure control relative to candesartan 32 mg monotherapy, with maintained tolerability, in hypertensive patients whose blood pressure is not optimally controlled with candesartan monotherapy. Furthermore, candesartan-HCT 32/25 mg is more effective than candesartan-HCT 32/12.5 mg in this population.

Comparison of the effects of candesartan cilexetil and enalapril maleate on right ventricular myocardial remodeling in dogs with experimentally induced pulmonary stenosis. [2008.12]
OBJECTIVE: To compare the effects of candesartan cilexetil and enalapril maleate on right ventricular myocardial remodeling in dogs with experimentally induced pulmonary stenosis... CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that treatment with candesartan but not enalapril effectively prevented myocardial remodeling in dogs with experimentally induced subacute right ventricular pressure overload.

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Clinical Trials Related to Atacand (Candesartan Cilexetil)

Atacand Dose Ranging in Hypertensive Pediatric Subjects 1 Year to Less Than 6 Years of Age [Active, not recruiting]
This is a dose ranging study of candesartan cilexetil in hypertensive pediatric subjects ages 1 to less than 6 years of age. It employs a double blind, randomized, dose ranging design intended for conduct as a multicenter trial. There are 3 study 'periods': a 1-week placebo run-in, a 4-week double blind treatment, and a 52-week open-label, long-term treatment period. Subjects undergo a screening evaluation, then a 1-week single-blind, placebo run-in, after which eligible subjects are allocated to receive 1 of 3 dose levels of candesartan cilexetil (0. 05 mg/kg, or 0. 20 mg /kg or 0. 40 mg /kg), liquid formulation, in a 1: 1:1 ratio for 4-weeks. At the end of randomized dose allocation (Day 28), blood pressure assessment will be performed and subjects may begin the 52-week, open-label treatment period of the study.

Compliance of Patients With Essential Hypertension Treated With Candesartan or Candesartan/Hydrochlorothiazide [Completed]
The CoCa study with at maximum daily dose of 32 mg candesartan or 16/12. 5 mg candesartan/hydrochlorothiazide has the objective to evaluate under naturalistic conditions, i. e. under routine medical care conditions, the subject compliance as well as the efficacy and tolerability of candesartan or candesartan/HCT in subjects suffering from essential hypertension.

Candesartan and Candesartan/ Hydrochlorothiazide in the Treatment of Patients With Hypertension and LVH [Completed]
The CandLE study with at maximum daily dose of 32 mg candesartan or 16/12. 5 mg candesartan/hydrochlorothiazide has the objective to evaluate under naturalistic conditions, i. e. under routine medical care conditions, the impact of the antihypertensive therapy with candesartan or candesartan/HCT on relevant medical parameters related to the left ventricular hypertrophy (LVH) as well as the efficacy and tolerability of candesartan or candesartan/HCT in subjects suffering from essential hypertension..

DIabetic Retinopathy Candesartan Trials. [Active, not recruiting]
The primary objective is to determine whether candesartan, compared to placebo reduces the progression of diabetic retinopathy in normotensive, normoalbuminuric type 1 diabetic patients with retinopathy.

The secondary objective is to determine whether candesartan, compared to placebo, reduces the incidence of clinically significant macular oedema (CSME) and/or proliferative diabetic retinopathy (PDR) and beneficially influences the rate of change in urinary albumin excretion rate (UAER).

This study is part of the DIRECT Programme also including a primary prevention study of diabetic retinopathy in type 1 diabetes and a secondary prevention study in type 2 diabetes. The primary objective for all three pooled studies is to determine whether candesartan, compared to placebo, reduces the incidence of microalbuminuria in type 1 and type 2 diabetic patients.

Antihypertensive Efficacy and Safety of Candesartan/HCT 32/12.5 and 32/25 mg in Comparison With Candesartan 32 mg [Completed]
In this study it is intended to compare the blood pressure lowering effect of the combination of candesartan cilexetil (candesartan) 32 mg and hydrochlorothiazide (HCT) 25 mg and the combination of candesartan 32 mg and HCT 12. 5 mg to that of candesartan 32 mg alone in patients whose blood pressure is not well controlled on candesartan 32 mg monotherapy. The Primary Objectives are to compare sitting BP lowering effect of candesartan/HCT 32/25 mg and candesartan/HCT 32/12. 5 mg with that of candesartan 32 mg, respectively.

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PATIENT REVIEWS / RATINGS / COMMENTS

Atacand review by 50 year old female patient
		Rating
Overall rating:
Effectiveness:		Considerably Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		high blood pressure
Dosage & duration:		16mg taken once a day for the period of 2 years
Other conditions:		none
Other drugs taken:		no other drugs but on HRT
		Reported Results
Benefits:		lowered blood pressure
Side effects:		I did experience some bowel changes although the doctor did not seem to think that this would be the result of the drug. I do, however. I experienced constipation.
Comments:		One 16 mg tablet to be taken daily. I had been given other blood pressure medication previously which I did not respond as well to so It took a few tries to get it right. I would like to be able to stop taking the medication and am trying to lose weight and lead a healthier lifestyle but all the literature seems to suggest that I may always need to take the medication.

Atacand review by 52 year old female patient
		Rating
Overall rating:
Effectiveness:		Considerably Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		high blood pressure
Dosage & duration:		16 mg taken once a day for the period of still on it, but only 8 mg/day
Other conditions:		atrial septal defect
Other drugs taken:		premarin
		Reported Results
Benefits:		The dizziness subsided, the auras appeared a lot more infrequently
Side effects:		tiredness
Comments:		After my cardiac procedure, I ended up with high blood pressure because my body was not sure how to deal with the change in my system. Where the blood was flowing from one atrium to the other was now closed and I was feeling so dizzy I had to look down at the ground to walk. I couldn't drive. I went to my doctor several times to try and find out what the trouble was. I monitered my blood pressure several times a day and was put on Atacand which seemed to work well. However, I found it made me so tired, that I took half a pill in the morning and half at night. Now my body has adjusted a lot, I am only on half the dose I started with. I also take a baby aspirin daily. I rely on Atacand to keep my blood pressure stable. Once in a while, if I start to feel dizzy or get an aura I take 1/2 a pill of Atacand and sit down for a bit and my symptons soon go away.

Atacand review by 52 year old female patient
		Rating
Overall rating:
Effectiveness:		Considerably Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		high blood pressure
Dosage & duration:		16 mg taken once a day for the period of still on it, but only 8 mg/day
Other conditions:		atrial septal defect
Other drugs taken:		premarin
		Reported Results
Benefits:		The dizziness subsided, the auras appeared a lot more infrequently
Side effects:		tiredness
Comments:		After my cardiac procedure, I ended up with high blood pressure because my body was not sure how to deal with the change in my system. Where the blood was flowing from one atrium to the other was now closed and I was feeling so dizzy I had to look down at the ground to walk. I couldn't drive. I went to my doctor several times to try and find out what the trouble was. I monitered my blood pressure several times a day and was put on Atacand which seemed to work well. However, I found it made me so tired, that I took half a pill in the morning and half at night. Now my body has adjusted a lot, I am only on half the dose I started with. I also take a baby aspirin daily. I rely on Atacand to keep my blood pressure stable. Once in a while, if I start to feel dizzy or get an aura I take 1/2 a pill of Atacand and sit down for a bit and my symptons soon go away.