Journal Article

Candesartan versus imidapril in hypertension: a randomised study to assess effects of anti-AT1 receptor autoantibodies

Gu, Ye, Wang, Li, Wei, Fen, Zhu, Feng, Yu, Su-Qin, Liao, Yu-Hua, Cheng, Xiang, Guo, Xiao-Mei, Zhou, Zi-Hua, Wang, Min, Jia, Xiu-Jie, Wei, Yu-Miao, Fu, Micheal

2011

Overview

BackgroundAnti-angiotensin II receptor subtype 1 (AT1 receptor) autoantibodies have previously been shown in sera of hypertensive patients. This study assessed whether anti-AT1-receptor autoantibody in serum is correlated with the efficacy of an AT1-receptor blocker (ARB; candesartan)-based regimen in hypertensive patients after 8 weeks of treatment.DesignThe Study of Optimal Treatment in Hypertensive Patients with Anti-AT1-Receptor Autoantibodies is a multicentre, randomised, blinded endpoint, open-label, parallel-group comparison clinical trial conducted in five centres in Wuhan, China. Treatment is designed as stepwise added-on therapy to reduce blood pressure (BP) <140/90 mm Hg. 512 patients with moderate to severe primary hypertension were randomly assigned to an 8-week treatment with either ARB (candesartan)-based regimen (n=257) or ACE inhibitor (imidapril)-based regimen (n=255).ResultsSystolic and diastolic BP was reduced significantly in both treatment groups. The candesartan-based regimen achieved a significantly greater systolic BP reduction than imdapril (30.8±10.3 vs 28.8±10.3 mm Hg, p=0.023). In those anti-AT1 receptor autoantibody-positive hypertensive patients, the mean systolic BP at baseline was higher than in the anti-AT1 receptor autoantibody-negative group (160.5±16.5 vs 156.2±17.7 mm Hg; p=0.006). The mean BP reduction was greater in the candesartan-based regimen than the imidapril-based regimen (−35.4±9.8/16.9±6.9 vs −29.4±9.8/14.2±6.9 mm Hg; p=0.000 and 0.002, respectively), and more patients on imidapril required add-on medications to achieve BP control (94% vs 86%; p=0.03). No correlation was observed between the titre of anti-AT1 receptor autoantibody and the efficacy of candesartan-based therapy. In those anti-AT1 receptor autoantibody-negative patients similar BP lowering was reached in the candesartan and the imidapril-based regimens.ConclusionsAn ARB-based regimen is more effective in BP lowering than an ACE inhibitor-based regimen in the presence of anti-AT1 receptor autoantibodies.Trial registration numberThis trial has been registered at http://www.register.clinicaltrials.gov/ (identifier: NCT00360763).

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group,BMJ Publishing Group LTD
• Subject: ACE inhibitors / Adult / adverse effects / Aged / Angiotensin / Angiotensin II Type 1 Receptor Blockers / Angiotensin II Type 1 Receptor Blockers - therapeutic use / angiotensin receptor blockers / Angiotensin-coverting enzyme inhibitors / Antihypertensive Agents / Antihypertensive Agents - adverse effects / Antihypertensive Agents - therapeutic use / Arterial hypertension. Arterial hypotension / Autoantibodies / Autoantibodies - blood / Benzimidazoles / Benzimidazoles - adverse effects / Benzimidazoles - therapeutic use / Biological and medical sciences / blood / Blood and lymphatic vessels / Blood Pressure / Blood Pressure - drug effects / Cardiology. Vascular system / Cardiovascular disease / Colleges & universities / Dermatologi och venereologi / Dermatology and Venereal Diseases / Double-Blind Method / drug effects / drug therapy / Female / Heart attacks / Humans / Hypertension / Hypertension - drug therapy / Hypertension - immunology / Hypertension - physiopathology / Imidazolidines / Imidazolidines - adverse effects / Imidazolidines - therapeutic use / immunology / Kinases / Male / Medical sciences / Microbiology in the Medical Area / Middle Aged / Mikrobiologi inom det medicinska området / physiopathology / Receptor / Receptor, Angiotensin, Type 1 - immunology / Tetrazoles / Tetrazoles - adverse effects / Tetrazoles - therapeutic use / therapeutic use / Treatment Outcome / Type 1