AHA: Antihypertensive Candesartan (Atacand) Reduces Diabetes Risk


ORLANDO, Nov. 9 -- The angiotensin-receptor blocker candesartan (Atacand) markedly reduced the risk of new-onset diabetes, despite failing to show significantly improved reduction in cardiovascular events."In comparison with standard therapy, candesartan-based therapy reduced by 11% the risk of major adverse cardiovascular events," Hiroshi Kasanuki, M.D., of Tokyo Women's Medical University, told attendees at the American Heart Association meeting here. "However," he said, "that was not statistically significant."
Action Points
Remind patients that getting blood pressure under control is important for treatment of both diabetes and kidney disease.
Note that this study was published as an abstract at a conference. The data and conclusions should be considered to be preliminary until published in a peer-reviewed publication.
On the other hand, Dr. Kasanuki said, new-onset diabetes occurred in just 1.1% of the 1,024 patients on candesartan compared with 2.9% of the patients treated with other blood pressure-lowering medications that did not include angiotensin-receptor blockers.
"Treatment with candesartan reduced that risk by 63% (P=0.027)," he said.
Dr. Kasanuki also noted that patients on candesartan had fewer adverse events than the 1,025 patients who received standard therapy.
"Treatment with candesartan reduced by 21% the risk of major adverse cardiovascular events in patients who entered the trial with impaired renal function (P=0.039)," he said.
The results come from HIJ-CREATE (Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease), a study that sought to determine if the newer angiotensin-II-receptor blockers such as candesartan were better than standard therapy that might include angiotensin-converting enzyme inhibitors, known to improve clinical outcomes in patients with coronary artery disease.
The randomized, prospective, open-label, blinded-endpoint study was conducted at 14 medical centers in Japan. The primary endpoint was a major cardiovascular event, including death, MI, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization.
Secondary endpoints included the incidence of revascularization and new-onset diabetes.
Dr. Kasanuki and colleagues enrolled patients who had angiographically documented coronary artery disease and had high blood pressure, defined as systolic blood pressure equal to or higher than 140 mm Hg and diastolic blood pressure equal to or greater than 90 mm Hg or were currently taking antihypertensive medication.
About 35% of the patients had acute coronary syndrome and about 65% had stable coronary artery disease. The patients had preserved left-ventricular ejection fraction. Patients were followed for five years.
Despite the failure to achieve a significant finding in the primary endpoint, Gordon Tomaselli, M.D., of Johns Hopkins and moderator of the session, said there were some take-home messages from the trial.
"With all due cautions about subgroup and post hoc analyses, some of these secondary endpoint results are intriguing," he said, "particularly for diabetes and possibly pre-diabetes, so you might think of utilization of this drug in those situations and in patients with chronic renal insufficiency."
Dr. Kasanuki provided no information on funding for the study or financial conflicts of interest. Dr. Tomaselli reported no conflicts of interest.Primary source: Source reference: Additional source: Final Program, American Heart Association 2007 Scientific SessionsSource reference: Kasanuki H, et al "Randomized Trial of ARB-based versus Non-ARB Standard Therapy in Patients with CAD and Hypertension" Final Program, American Heart Association 2007 Scientific Sessions; 60.