Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate

Abstract

Early morning hypertension and a high heart rate are risk factors for cardiovascular disease. The DOHSAM study was designed to evaluate the effect of candesartan on early morning blood pressure (BP) and heart rate in hypertensives. We used a prospective, randomized, open-label design. Protocol 1: Patients with early morning BP more than 135/85 mmHg who were not on any antihypertensive drug or on candesartan were given amlodipine 2.5 mg/day (amlodipine group, n = 22) or added candesartan 4 mg/day (candesartan group, n = 36). Candesartan or amlodipine was added when BP did not fall lower than 135/85 mmHg. Protocol 2: Early morning hypertensives who were on other angiotensin receptor blockers (ARBs) (n = 50) such as valsartan, losartan, telmisartan and olmesartan were switched to candesartan. Early morning BP significantly decreased in the candesartan group compared with the amlodipine group 9 and 12 months after treatment. Switching other ARBs except for olmesartan to candesartan significantly decreased early morning systolic and diastolic BP 3, 6, 9 and 12 months after treatment. Heart rate in the office significantly decreased by switching to candesartan 6, 9 and 12 months after treatment. In conclusion, candesartan significantly decreased early morning hypertension more than amlodipine or other ARBs except olmesartan in early morning hypertensives.

Key words::

• Angiotensin II receptor blocker
• candesartan
• early morning hypertension
• heart rate

Acknowledgement

We thank all participants, physicians, medical staff and other contributors to the DOHSAM study.

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Appendix

Members of the DOHSAM study are as follows:

Naoki Kawai (Kawai Clinic, Gifu), Mitsunori Iwasa (Iwasa Clinic, Hashima, Gifu), Masayuki Oda (Oda Clinic, Hashima, Gifu), Keiji Kida (Kida Clinic, Kakamigahara, Gifu), Syojiro Kojima (Kojima Clinic, Ogaki, Gifu), Naomi Goto (Goto Clinic, Gifu), Masahiro Goto (Goto Clinic, Gifu), Fusayoshi Sugishita (Sugishita Clinic, Gujyo, Gifu), Kuniyuki Takai (Takai Clinic, Gifu), Ryuhei Tanaka (Tanaka, Hagiwara, Gifu), Keiji Hiei (Hiei Clinic, Minogamo, Gifu), Taro Minagawa (Minagawa Clinic, Gifu), Noritaka Yamamoto (Yamamoto Clinic, Gifu), Ikuo Watanabe (Watanabe Clinic, Ogaki, Gifu), Takao Yasue (Yasue Clinic, Gifu), Hiroshi Kobayashi (Konayashi Clinic, Kakamigahara, Gifu)