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93 A Double-Blind Placebo-Controlled Randomised Study of the Effects of Candesartan Versus Amlodipine on Capillary Rarefaction in Essential Hypertension
  1. Rajendra Raghuraman1,
  2. Christine Carney2,
  3. Oluwabusola Ogunseitan2,
  4. Helen Mullahy2,
  5. Duolao Wang3,
  6. Tarek Antonios4
  1. 1St. George’s, University of London
  2. 2St. George’s University Hospitals NHS Foundation Trust
  3. 3Liverpool School of Tropical Medicine
  4. 4SGUL

Abstract

Background A reduction in the density of capillaries (rarefaction) is known to occur in many tissues in patients with essential hypertension (HTN) and plays a crucial role in increasing peripheral resistance and blood pressure (BP). The aim of this clinical trial was to assess in a controlled, double blind, placebo-controlled design the effects of treatment of HTN with candesartan or amlodipine on microvascular rarefaction and other indices of vascular function in individuals with mild-to-moderate essential HTN.

Methods The capillary microcirculation was studied using the well-validated intravascular microscopy technique. After a 2-week single-blind placebo run-in period, patients who remained hypertensive (systolic BP 140–180 mmHg and/or diastolic BP 90 –110 mmHg) were randomised to 8-weeks treatment with either candesartan 8 mg daily (with forced titration to 16mg after 2 weeks) or amlodipine 5 mg orally daily (with forced titration to 10 mg after 2 weeks). Other vascular measurements included pulse wave velocity with Complior machine, central BP and Aortic Augmentation Index measurements with Omron HEM-9000AI machine.

Results Treatment with candesartan and amlodipine significantly reduced both brachial and central BP at 4 and 8 weeks (mean change -19.0 mmHg; 95% CI -−11.1 to -−26.9, p < 0.0001), and to 8 weeks active treatment (mean change -26.3 mmHg; 95% CI −17.5 to −35.0, p < 0.0001) but had no significant effect on basal (functional) or maximal (structural) capillary densities. Both drugs also reduced central BP and Aortic augmentation index significantly after 4 and 8 weeks but there was no significant changes in PWV.

Conclusions The study confirms that 8 weeks treatment with either candesartan or amlodipine significantly reduces radial and central BP in essential HTN but may not be a sufficient circumstance for inducing a regression in microvascular abnormalities.

  • Hypertension
  • Microcirculation
  • Capillary rarefaction

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