Effects of candesartan and amlodipine on cardiovascular events in hypertensive patients with chronic kidney disease

Subanalysis of the CASE-J Study

Takao Saruta, Koichi Hayashi, Toshio Ogihara, Kazuwa Nakao, Tsuguya Fukui, Kohshiro Fukiyama

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

We examined the effects of candesartan and amlodipine on cardiovascular events in hypertensive patients with chronic kidney disease (CKD) using the data from the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial. CKD was defined as proteinuria and/or decreased GFR (<60 ml per min per 1.73 m2) at enrollment. Among 2720 subjects with CKD, there were 1376 and 1344 patients in the candesartan and the amlodipine group, respectively. During a 3.2-year follow-up, cardiovascular event rate did not differ in the two groups (7.2% for candesartan and 7.6% for amlodipine). In the subgroup analysis based on the CKD stage, there were no significant differences in the incidence rates of cardiovascular events between the two groups in stages 1+2 and 3 CKD. In stage 4 CKD, however, candesartan reduced the incidence of cardiovascular events (55% risk reduction), particularly of renal events (81% risk reduction), compared with amlodipine. Furthermore, composite cardiovascular events were increased as the CKD stage progressed, and this effect was exaggerated in the presence of proteinuria. Finally, the new onset of diabetes was less in the candesartan-based regimen in stage 3 CKD. In conclusion, candesartan protected hypertensive patients with CKD more potently against renal events, particularly in moderately-to-severely impaired CKD. Furthermore, candesartan prevented a new onset of diabetes in CKD, which would be favorable for the long-term management of CKD.

Original languageEnglish
Pages (from-to)505-512
Number of pages8
JournalHypertension Research
Volume32
Issue number6
DOIs
Publication statusPublished - 2009

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Amlodipine
Chronic Renal Insufficiency
Antihypertensive Agents
Japan
Survival
Risk Reduction Behavior
Proteinuria
candesartan
Kidney
Incidence

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Effects of candesartan and amlodipine on cardiovascular events in hypertensive patients with chronic kidney disease : Subanalysis of the CASE-J Study. / Saruta, Takao; Hayashi, Koichi; Ogihara, Toshio; Nakao, Kazuwa; Fukui, Tsuguya; Fukiyama, Kohshiro.

In: Hypertension Research, Vol. 32, No. 6, 2009, p. 505-512.

Research output: Contribution to journalArticle

Saruta, Takao ; Hayashi, Koichi ; Ogihara, Toshio ; Nakao, Kazuwa ; Fukui, Tsuguya ; Fukiyama, Kohshiro. / Effects of candesartan and amlodipine on cardiovascular events in hypertensive patients with chronic kidney disease : Subanalysis of the CASE-J Study. In: Hypertension Research. 2009 ; Vol. 32, No. 6. pp. 505-512.
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