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Candesartan Is Better Than Amlodipine for Diabetes Prevention

Candesartan and amlodipine are similarly effective in preventing cardiovascular events in high-risk hypertensive patients, the results of a study suggest. However, candesartan is more effective for the prevention of new-onset diabetes. To compare the long-term effects of the angiotensin II receptor blocker candesartan and the calcium channel blocker amlodipine, Dr. Kazuwa Nakao, of the Kyoto University Graduate School of Medicine, and colleagues conducted a prospective, open-label study that included 4703 hypertensive patients. The subjects’ mean age and BMI were 63.8 years and 24.6, respectively.

The primary end-point of the Candesartan Antihypertensive Survival Evaluation in Japan Trial was a composite of sudden death and cerebrovascular, cardiac, renal, and vascular events. Secondary end points included all-cause deaths, new-onset diabetes, and discontinuation of treatment due to adverse events.

Systolic and diastolic blood pressure was well-controlled in both groups at 3-year follow-up. One hundred thirty-four patients experienced primary cardiovascular events, but there were no significant differences in cardiovascular morbidity and mortality between the two groups of patients (HR 1.01; p = 0.969).

"New-onset diabetes occurred in significantly fewer patients treated with candesartan-based regimens (8.7/1000 person-years) than in those treated with amlodipine-based regimens (13.6/1000 person-years)," Dr. Nakao and colleagues report. "A 36% relative risk reduction was observed for the incidence of new-onset diabetes with the candesartan-based regimens (HR 0.64; p = 0.033)."

The authors report that 125 patients in the candesartan group (5.4%) and 134 in the amlodipine group (5.8%) discontinued treatment because of adverse events.

Dr. Nakao’s group notes that their results may not apply to other populations; the cardiovascular event and obesity rates in Japan and other Asian countries differ from those seen in the U.S. and European countries – and their study population all had similar lifestyles and genetic predispositions. "As far as we know, there is no published evidence about the efficacy of angiotensin receptor blockers in mildly obese populations," they add.

Hypertension 2008;51:393-398.

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FACT:
Diabetes, Cholesterol, Anti-obesity Drugs Top Spending: U.S. adult consumers spent nearly $36 billion for prescription drugs to lower blood sugar, reduce cholesterol, or help with other metabolic problems in 2005. The Total for all prescriptions was $199 billion dollars.  This comes from the Agency for Healthcare Research and Quality. 
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