What Benefits Does the Fixed Combination of Candesartan/Amlodipine Bring?

Ways to Achieve the Highest Possible Patient Compliance

Angiotensin-converting enzyme inhibitors (ACEi) and AT₁ receptor blockers (ARBs; sartans) both act on the renin-angiotensin-aldosterone system (RAAS). Their different pharmacological properties are due to the fact that each of these drug groups affects RAAS at a different level.

Both drug groups have a good safety profile in monotherapy and in combination with other antihypertensives, such as calcium channel blockers (CCBs), including amlodipine. The synergistic effects of ACEi/sartans + CCBs on blood pressure reduction have been demonstrated in numerous clinical studies. Using a fixed combination is more convenient for the patient as they don't have to take two tablets.

Unlike ACEi, the use of sartans does not result in side effects caused by the accumulation of bradykinin in tissues (cough, angioedema). This fact is associated with higher compliance by patients. A dry cough is indeed the most common cause of interruption of antihypertensive therapy.

Cardioprotective Effects of Sartans

RAAS blockers play an important role in the prevention and treatment of cardiovascular diseases. Blocking AT₁ receptors contributes to the protective effects of sartans also by increasing the activity of angiotensin II on AT₂ receptors, resulting in arteriole vasodilation and increased natriuresis. In patients treated with sartans, the reduction in blood pressure, overall and cardiovascular mortality, and incidence of acute myocardial infarction is comparable to the results with ACEi. However, a significant difference is the better tolerability of sartans mentioned above.

Sartans are indicated for patients with comorbidities such as microalbuminuria, chronic kidney disease, renal insufficiency, metabolic syndrome, type 1 and 2 diabetes mellitus, atherosclerosis, stable angina pectoris, post-acute myocardial infarction state, or atrial fibrillation. They are also advantageously prescribed to patients with high blood pressure and a risk of developing dementia. Specifically, candesartan is also suitable for patients with a diagnosis of heart failure. Moreover, it reduces the risk of newly occurring atrial fibrillation or stroke in hypertensive patients with a high risk of cerebrovascular accident.

Conclusion

The fixed combination of sartan/calcium channel blocker is at least as effective in reducing blood pressure as the combination of ACEi/CCB. Candesartan, however, has better tolerability compared to ACE inhibitors, leading to fewer side effects and better compliance by patients to treatment.

(mafi)

Sources:
1. Monhart V. AT₁ Blockers - Comparability of Cardioprotection with ACE Inhibitors. Internal Medicine 2017; 63 (4): 267–271.
2. Vítovec J., Špinar J. What does the fixed combination of candesartan and amlodipine bring? Internal Medicine 2016; 62 (4): 317–321.