Cardio classics revisited – focus on the role of candesartan

Abstract

Angiotensin II receptor blockers (ARBs) are antihypertensive agents with considerable evidence of efficacy and safety for the reduction of cardiovascular (CV) disease risk in numerous patient populations across the CV continuum. There are several agents within this class, all of which have contributed to various degrees, to this evidence base. The evidence with ARBs continues to accumulate, with ongoing trials investigating their role in additional patient populations, potentially expanding their efficacy across a broad spectrum of CV disease states. Cardiovascular disease (CVD) is a leading cause of death around the world, accounting for approximately 29.2% of total global deaths. Of all the deaths attributed to CVD, approximately 43% are due to ischemic heart disease, 33% to cerebrovascular disease, and 23% to hypertensive and other heart conditions. CVD has been represented as a “CV continuum”. This continuum concept can be used to describe CVD in general or in specific vascular beds (eg, coronary artery disease or cerebrovascular disease). This review article will discuss the results of the landmark ARB candesartan clinical trials published over the past decade. The evidence presented spans the entire CV continuum, including the effects of ARBs in at-risk patients, stroke, myocardial infarction (MI), and heart failure (HF), as well as a brief discussion of ongoing trials.

Sartans in the Practice of a Cardiologist

“…Кандесартан снижал относительный риск сердечно-сосудистой смерти или госпитализации по поводу сердечной недостаточности у пациентов с фракцией выброса левого желудочка ≤40% и непереносимостью ингибиторов АПФ на 23%, а у пациентов с фракцией выброса левого желудочка ≤40%, получавших ингибиторы АПФ, -на 15% (41 месяц) по сравнению с плацебо. У пациентов с сохраненной систолической функцией прием кандесартана (36,6 месяца) не влиял на риск сердечно-сосудистой смертности и заболеваемости по сравнению с плацебо [28,29].…”

Effects of the AT1 Receptor Blocker Candesartan on Myocardial Ischemia/Reperfusion in Isolated Rat Hearts

“…Furthermore, at higher concentrations of ANG II, the drug does not easily separate from its receptor. This firm and prolonged binding provides effective blockage and reduces the adverse cardiovascular effects of ANG II [De Rosa 2010]. Candesartan almost completely eliminates ANG II by reducing the maximum response.…”