Candesartan Improves Maximal Exercise Capacity in Hypertensives: Results of a Randomized Placebo‐Controlled Crossover Trial

Abstract

Cardiac hypertrophy and remodelling in hypertension has been associated with impaired exercise capacity. The authors tested whether an angiotensin receptor blocker, candesartan, improved exercise peak oxygen volume (VO 2 ) in this population. A total of 154 untreated hypertensive patients, aged 40 to 66 years, with World Health Organization stage I or II hypertension and left ventricular hypertrophy, were randomized to receive placebo, candesartan (32 mg), each of these plus aspirin (300 mg ⁄ d), or the same preparations in a reverse order, for 3 weeks, with a 3-week washout period between treatments. The authors measured maximal workload and oxygen reserve with an exercise test, 24 hour-ambulatory blood pressure, and echocardiography at the end of each treatment. Hypertensive patients did not achieve the maximal workload (116 [99-133] W vs 132 (AMA style = no period on vs) [116-149] W; P=.01). This impaired exercise capacity was in a multiple regression analysis related to lower oxygen reserve (r=0.49, P<.001), and the lower oxygen reserve to higher left ventricular hypertrophy by echocardiography (b=)0.34), respectively. The use of candesartan alone or with aspirin resulted in an improvement of peak VO 2 and exercise tolerance, when compared with controls. Patients with hypertension and cardiac hypertrophy cannot achieve a predicted maximal workload. The use of an angiotensin receptor blocker in therapy may represent a useful treatment in these patients for its effect on exercise peak VO 2 and exercise tolerance. The use of aspirin did not affect outcome.

Angiotensin II receptor blocker improves the lowered exercise capacity and impaired mitochondrial function of the skeletal muscle in type 2 diabetic mice

“…However, the enhancement of exercise capacity by telmisartan was associated with the decrease in body weight gain and was considered to be due to the activation of peroxisome proliferator activated receptor ␦ rather than the inhibition of AT1R in their study. Candesartan has been also demonstrated to improve exercise capacity in patients with hypertension, which, however, was accompanied with the reduction of blood pressure (8). Importantly, the beneficial effects of OLM on exercise capacity shown in the present study were independent of blood pressure, body weight, or glucose metabolism (Table 1 and Fig.…”

Cardio classics revisited &ndash; focus on the role of candesartan

“…Furthermore, candesartan may represent an alternative in hypertensive patients for its efficacy on exercise peak VO2 and exercise tolerance, because of similar efficacy of ACE inhibitor for exercise performance and less exposure to the counteracting activity of aspirin. 98 …”

“…Furthermore, candesartan may represent an alternative or even an advancement in hypertensives for its efficacy on exercise VO2 and exercise tolerance, without antagonism by aspirin. 98 …”

Activation of AMPK and its Impact on Exercise Capacity

“…AMPK activation has also been reported after administration of other angiotensin receptor blockers ('sartans') such as losartan, olmesartan, or candesartan [80][81][82]. Some of these drugs were also associated with improved exercise capacity [83][84][85], but this effect was not directly linked to AMPK activation.…”