From the Guidelines
Candesartan is recommended as an additional treatment to ACE inhibitors for patients with mild to severely symptomatic heart failure, as it has been shown to reduce the risk of heart failure hospitalization and cardiovascular death, with a number needed to treat (NNT) of 23 over 41 months, as demonstrated in the CHARM-Added trial 1. The use of candesartan in heart failure is supported by several key trials, including the Valsartan Heart Failure Trial (Val-HeFT) and the CHARM-Added trial, which randomized over 7,600 patients to receive an angiotensin II receptor blocker (ARB) or placebo, in addition to an ACE inhibitor and other conventional treatments 1. Some key benefits of candesartan include:
- Reduction in the risk of heart failure hospitalization, with a relative risk reduction (RRR) of 17% in the CHARM-Added trial 1
- Reduction in the risk of cardiovascular death, with a RRR of 16% in the CHARM-Added trial 1
- Improvement in symptoms and quality of life, as demonstrated in the CHARM trials and Val-HeFT 1
- Improvement in exercise capacity, as shown in other trials 1 The typical starting dose of candesartan for heart failure is 4 mg once daily, which can be gradually increased to a target dose of 32 mg daily as tolerated, with regular monitoring of blood pressure, kidney function, and potassium levels 1. It is essential to note that candesartan should be used with caution in patients with renal impairment and those at risk of hyperkalemia, and it is contraindicated during pregnancy due to the risk of fetal harm 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Overview of Candesartan
- Candesartan is a novel high-affinity type 1 AT(1)-receptor blocker characterized by prolonged binding to and slow dissociation from the receptor 2.
- It has pronounced and lengthy (24-36 hours) antihypertensive action which does not depend on patients' sex, age, and body mass 2.
Renal Protective Effects
- Candesartan has been associated with regression of left ventricular hypertrophy, renoprotective effect, and lowered risk of stroke 2.
- Angiotensin II receptor blockers (ARBs), including candesartan, have extensive data showing their renal protective benefits in hypertensive type 2 diabetic patients with microalbuminuria or proteinuria 3.
- The benefits of ARBs are over and above that of blood pressure reduction alone and extend to normotensive diabetic patients as well 3.
Clinical Practice
- Candesartan-based therapy is effective in lowering blood pressure while providing improved compliance, a good tolerability, and largely neutral metabolic profile 4.
- Fixed drug-drug combinations of candesartan and hydrochlorothiazide are highly effective in lowering blood pressure 4.
- Candesartan cilexetil has more than 1000 times more affinity for the angiotensin II, type AT1 receptor, and the binding affinity and competitive angiotensin II receptor antagonism is stronger than that of losartan 5.