Stichting Bouwresearch

The pharmacokinetics and pharmacodynamics of antihypertensive drugs are often influenced by age, and may be different in elderly and younger patients. The choice of drug and dosage in the elderly therefore merits special consideration. The aim of this placebo-controlled study was to determine the efficacy and tolerability of the angiotensin II type 1 (AT 1 ) receptor blocker candesartan cilexetil with placebo in elderly patients with primary hypertension. Men and women, aged 65 years or older and with supine diastolic blood pressure (DBP) of 95-114 mmHg, were randomized to double-blind, once-daily treatment with candesartan cilexetil, 8 mg ( n = 96), or placebo ( n = 97) for 12 weeks. The dose was increased to 16 mg once daily if DBP was greater than 90 mmHg after 6 weeks of treatment. Forty-nine per cent of the patients remained on the 8 mg dose. At each visit, systolic blood pressure (SBP) and DBP were measured 24 h after dosing. After the first dose following randomization, blood pressure was also measured at 2 and 4 h. Placebo-corrected changes in supine blood pressure with candesartan cilexetil are shown in the Table. At the end of the study, the mean reductions in placebo-corrected supine DBP and SBP in patients receiving candesartan cilexetil were 7.5 mmHg and 13.6 mmHg, respectively ( p < 0.001 vs placebo). The incidence of adverse events in this treatment group was similar to that in the placebo group. Only four patients in the candesartan cilexetil group withdrew due to adverse events, compared with ten in the placebo group. There was no evidence of an orthostatic effect. In conclusion, in elderly hypertensive patients, candesartan cilexetil, 8-16 mg once daily, is an effective and well-tolerated antihypertensive treatment, which has a smooth onset of action and no exaggerated response after the first dose.