Comparative efficacy of losartan and candesartan in hypertensive patients and their effect on circadian blood pressure profile

To assess the comparative effectiveness of antihypertensive therapy by an angiotensin receptor antagonist - Losartan or Candesartan - in patients with uncontrolled ambulatory arterial hypertension (AH). Design and methods. The study included 60 patients aged from 35 to 65 years divide into two groups. The first group included 31 hypertensive patients (15 men and 16 women, mean age 46,1 ± 9,9 years) receiving losartan. The second group was formed by 29 patients (12 men and 18 women, mean age 47,2 ± 9,8 years) with long-term hypertension receiving candesartan. Hypertension was diagnosed based on history and results of clinical and instrumental examination: blood tests, urinalysis, electrocardiogram, echocardiography, repeated 24-hour monitoring of blood pressure (BP) («BPLab» MnSDP-2) (at baseline and 4 weeks after drug administration). Results. Candesartan has significant benefits over losartan on the effect on circadian BP profile (reduction of the daily index of systolic BP by 5,8 and 4,8 % respectively, p < 0,05), reduction in the average values and variability of systolic BP (during the day by 38,0 and 27,1 % respectively, p < 0,05) and diastolic BP (daytime values by 25 and 18,3 %, p < 0,01, and at night - by 28,1 and 21,9 %, p < 0,05). Response to antihypertensive therapy was 90 % regarding systolic and 89 % - regarding diastolic BP change. Conclusion. Candesartan is not only more effective regarding the impact on the average values of BP, but also with regard to the variability of BP as a predictor of cardiovascular complications, which in turn might have a positive predictive value.

hypertension, angiotensin receptor antagonists, 24-hour blood pressure monitoring, efficiency evaluation