Effect of azilsartan versus candesartan on morning blood pressure surges in
Japanese patients with essential hypertension.
Author(s): Rakugi H(1), Kario K, Enya K, Sugiura K, Ikeda Y.
Affiliation(s): Author information:
(1)aDepartment of Geriatric Medicine and Nephrology, Osaka University Graduate
School of Medicine bDrug Development Division, Pharmaceutical Development
Division, Takeda Pharmaceutical Company Limited, Osaka cDepartment of Medicine,
Division of Cardiovascular Medicine, Jichi Medical University School of Medicine,
Tochigi-ken, Japan.
Publication date & source: 2014, Blood Press Monit. , 19(3):164-9
Morning blood pressure (BP) surge is reported as a risk factor for cardiovascular
events and end-organ damage independent of the 24-h BP level. Controlling morning
BP surge is therefore important to help prevent onset of cardiovascular disease.
We compared the efficacy of azilsartan and candesartan in controlling morning
systolic BP (SBP) surges by analyzing relevant ambulatory BP monitoring data in
patients with/without baseline BP surges. As part of a 16-week randomized,
double-blind study of azilsartan (20-40 mg once daily) and candesartan (8-12 mg
once daily) in Japanese patients with essential hypertension, an exploratory
analysis was carried out using ambulatory BP monitoring at baseline and week 14.
The effects of study drugs on morning BP surges, including sleep trough surge
(early morning SBP minus the lowest night-time SBP) and prewaking surge (early
morning SBP minus SBP before awakening), were evaluated. Patients with sleep
trough surge of at least 35 mmHg were defined by the presence of a morning BP
surge (the 'surge group'). Sleep trough surge and prewaking surge data were
available at both baseline and week 14 in 548 patients, 147 of whom (azilsartan
76; candesartan 71) had a baseline morning BP surge. In surge group patients,
azilsartan significantly reduced both the sleep trough surge and the prewaking
surge at week 14 compared with candesartan (least squares means of the
between-group differences -5.8 mmHg, P=0.0395; and -5.7 mmHg, P=0.0228,
respectively). Once-daily azilsartan improved sleep trough surge and prewaking
surge to a greater extent than candesartan in Japanese patients with grade I-II
essential hypertension.
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