When should the dose of Atacand (candesartan) be increased in a patient with uncontrolled hypertension?

From the Guidelines

The dose of Atacand (candesartan) should be increased to 32 mg daily in 1-2 divided doses if blood pressure remains uncontrolled, as this is the goal dose recommended for adults with hypertension 1. When considering a dose increase, it's essential to assess the patient's current blood pressure and determine if it's above the target level of 130/80 mm Hg.

• Key factors to consider before increasing the dose include:
  • Patient adherence to the current medication regimen
  • Presence of factors that may contribute to treatment resistance, such as high sodium intake or concurrent medications that may raise blood pressure
  • Potential secondary causes of hypertension
• The typical starting dose of Atacand is 16 mg once daily, and dose adjustments should be made gradually, allowing sufficient time between increases to assess the full effect of the current dose 1.
• For patients with specific conditions, such as hepatic or renal impairment, or those taking diuretics, careful consideration should be given to the starting dose and titration schedule.
• Candesartan's full antihypertensive effect typically develops within 2-4 weeks, making this timeframe crucial for dose assessment and potential adjustment 1.
• It's also important to note that higher levels of blood pressure are associated with more rapid progression of kidney disease, and ACE inhibitors and ARBs, like candesartan, are effective in slowing this progression in hypertensive patients with diabetes 1.

From the FDA Drug Label

The usual recommended starting dose of candesartan cilexetil is 16 mg once daily when it is used as monotherapy in patients who are not volume depleted. Candesartan cilexetil can be administered once or twice daily with total daily doses ranging from 8 mg to 32 mg. Patients requiring further reduction in blood pressure should be titrated to 32 mg A patient whose blood pressure is not controlled on 32 mg of candesartan cilexetil can expect incremental blood pressure effects from candesartan cilexetil and hydrochlorothiazide tablets 32 mg/12. 5 mg and then 32 mg/25 mg.

The dose of Atacand (candesartan) should be increased in a patient with uncontrolled hypertension if the patient is not at the maximum recommended dose of 32 mg. The dose can be titrated up to 32 mg for patients requiring further reduction in blood pressure. However, doses larger than 32 mg do not appear to have a greater blood pressure lowering effect 2.

From the Research

Atacand Dose Increase

When considering a dose increase of Atacand (candesartan) in a patient with uncontrolled hypertension, several factors should be taken into account.

• The initial dose of candesartan cilexetil is typically 8 mg or 16 mg once daily, and it can be titrated upwards to 32 mg once daily if necessary 3.
• Studies have shown that candesartan cilexetil is effective in reducing blood pressure in patients with mild to moderate essential hypertension, and its efficacy is comparable to other antihypertensive agents such as enalapril, losartan potassium, hydrochlorothiazide, and amlodipine 3.
• However, before increasing the dose, it is essential to assess the patient's compliance with their current medication regimen, as poor compliance can be a significant cause of uncontrolled hypertension 4.
• The choice of antihypertensive drug can also impact compliance, and long-acting agents like candesartan cilexetil may be beneficial in patients with poor adherence to their medication regimen 4.
• In patients with renal or hepatic impairment, the pharmacokinetics of candesartan cilexetil may be altered, and a lower starting dose may be necessary in those with severe renal impairment 5.
• Recent guidelines suggest that blood pressure targets should be lowered to 130/80 mmHg or lower in patients under 65 years old, which may lead to an increase in the number of patients classified as having uncontrolled hypertension 6.
• In such cases, intensifying pharmacological treatment, including increasing the dose of Atacand, may be considered, but lifestyle modifications such as weight reduction and improved medication adherence should also be emphasized 6.

Considerations for Dose Increase

Before increasing the dose of Atacand, the following should be considered:

• The patient's current blood pressure readings and their target blood pressure goals.
• The patient's renal and hepatic function, as this may impact the pharmacokinetics of candesartan cilexetil.
• The patient's compliance with their current medication regimen and any potential barriers to adherence.
• The potential benefits and risks of increasing the dose, including the potential for improved blood pressure control and the risk of adverse effects.