atients with hypertension often develop left ventricular (LV) hypertrophy as a physical response to chronic pressure overload, and it can result in decreased chamber compliance and eventually lead to the deterioration of LV systolic function. Any of these changes contribute to the development of heart failure. Angiotensin II is now believed to play a critical role in the pathogenesis of hypertrophy and/or hyperplasia of vascular smooth muscle cells, 1-6 and angiotensin II receptor blockers (ARBs) are a new class of effective and well-tolerated orally active antihypertensive agents. 7 Recent clinical trials have shown various benefits of ARB therapy in hypertensive patients, including the reduction of LV hypertrophy, 6-17 improvement in diastolic function, 18 improvement in endothelial function 19-22 and a cardioprotective effect in patients with heart failure. [23][24][25] Candesartan cilexetil, a new angiotensin II type 1 (AT1) receptor blocker, shows strong and long-lasting binding to the AT1 receptor and thus provides 24-h control of blood pressure (BP) while blocking the major negative cardiovascular effects of angiotensin II. 10 The beneficial effects of candesartan have been reported, [5][6][7][9][10][11][12][13][14][15][16][17]21,22 but there has not been a study that followed both cardiac status Circulation Journal Vol.66, November 2002 and endothelial function in hypertensive patients for up to 12 months. Accordingly, we instigated the present study of the effects of candesartan on LV function, LV hypertrophy, and endothelial function in patients with hypertensive heart disease (HHD) during a 1-year period.
Methods
PatientsThirty-four patients with HHD were recruited and received candesartan (8 mg/day) therapy. However, 5 patients took the agent either irregularly or ceased taking it entirely and they were excluded. We divided the remaining 29 patients into 2 groups on the basis of BP control: poor control (group P, n=6) and good control (group C, n=23). The six patients in group P had systolic BP ≥170 mmHg or diastolic BP ≥100 mmHg at 6 months after drug administration and required other antihypertensive agents, so only the data up until 6 months were analyzed and compared with the data from group C.The 23 patients in group C were followed for 12 months. All patients in groups P and C had a history of primary hypertension, with systolic BP ≥160 mmHg and diastolic BP ≥90 mmHg measured at the outpatient clinic at the beginning of this study, with and without previous antihypertensive therapy. They had LV hypertrophy (interventricular septal (IVS) thickness ≥12 mm) and diastolic dysfunction was evaluated by echocardiography. In our study, an A/E ratio [ratio of the peak velocity of atrial filling (A) to that of early diastolic filling (E) for transmitral Twenty-nine patients with hypertensive heart disease (HHD) underwent echocardiography, radionuclide ventriculography and the measurement of endothelial function before and after administration of candesartan (8 mg/day). The subjects were divided into p...