Candesartan, an angiotensin II type-1 receptor blocker, reduces cardiovascular events in patients on chronic haemodialysis—a randomized study

• Published in: Nephrology, dialysis, transplantation Vol. 21; no. 9; pp. 2507 - 2512
• Main Authors: Takahashi, Akihiko, Takase, Hiroyuki, Toriyama, Takayuki, Sugiura, Tomonori, Kurita, Yutaka, Ueda, Ryuzo, Dohi, Yasuaki
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.2006; Oxford Publishing Limited (England)
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angiotensin II Type 1 Receptor Blockers - therapeutic use; angiotensin receptor antagonists; Associated diseases and complications; Benzimidazoles - therapeutic use; Biological and medical sciences; brain natriuretic peptide; cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; cardiovascular mortality; congestive heart failure; Diabetes. Impaired glucose tolerance; Emergency and intensive care: renal failure. Dialysis management; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Follow-Up Studies; Humans; Incidence; Intensive care medicine; Japan - epidemiology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Proportional Hazards Models; Prospective Studies; randomized trail; Renal Dialysis - adverse effects; Renal failure; Survival Rate; Tetrazoles - therapeutic use; Treatment Outcome; Japan; Tetrazole derivatives; Candesartan; Hemodialysis; Peptide hormone; Cardiovascular disease; Extrarenal dialysis; Octapeptide; Heart disease; randomized trail; congestive heart failure; angiotensin receptor antagonists; Angiotensin II; Kidney disease; Human; Heart failure; Brain natriuretic peptide; Urinary system disease; Mortality; cardiovascular mortality; AT1 angiotensin receptor; Benzimidazole derivatives; Biphenyl derivatives; Renal failure; Antihypertensive agent; Angiotensin antagonist
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfl293

Background. Cardiovascular events are the major determinants of the prognosis of patients on chronic haemodialysis. The present study was designed to investigate whether candesartan, an angiotensin II type-1 receptor blocker, reduces the incidence of cardiovascular events in these patients. Methods. A total of 80 chronic haemodialysis patients (male/female, 47/33; mean age ± SEM, 61 ± 1 years) in stable condition and with no clinical evidence of cardiac disorders were enrolled. Patients were randomly assigned candesartan 4–8 mg/day (candesartan group; n = 43) or nothing (control group; n = 37), and followed for 19.4 ± 1.2 months with as endpoint cardiovascular events such as fatal/nonfatal myocardial infarction, unstable angina pectoris, congestive heart failure, severe arrhythmia and sudden death. Results. Both groups exhibited similar clinical characteristics at baseline. During follow-up, cardiovascular events occurred in seven patients in the candesartan group and 17 in the control group. Kaplan–Meier analysis revealed that cardiovascular events and mortality rates were significantly (P < 0.01) higher in the control group than in the candesartan group (45.9 vs 16.3% and 18.9 vs 0.0%, respectively). Conclusions. Candesartan therapy significantly reduces cardiovascular events and mortality in patients on chronic maintenance haemodialysis and therefore improves the prognosis of these patients.