Candesartan cilexetil: comparison of once-daily versus twice-daily administration for systemic hypertension. Candesartan Cilexetil Study Investigators.

This randomized, double-masked, placebo-controlled, forced-titration, parallel-arm study was designed to compare the blood pressure (BP)-lowering effect of candesartan cilexetil, a potent antagonist of the angiotensin II receptor subtype AT1, administered once daily with that of the same agent administered twice daily at the same total daily dose of 16 mg. After a 4- to 5-week placebo run-in period, 277 patients with a sitting diastolic BP of 95 to 109 mm Hg were randomly allocated to receive placebo (n = 92) or candesartan cilexetil 8 mg once daily for 4 weeks, followed by forced titration to either 16 mg once daily (n = 91) or 8 mg twice daily (n = 94) for 4 weeks. At 8 weeks, mean reductions in trough sitting diastolic BP were similar for the once- and twice-daily treatment groups (9.4 and 10.3 mm Hg, respectively). After 8 weeks of treatment, no statistically significant differences were observed in diastolic or systolic BP, peak or trough BP, or sitting or standing BP between the 2 active-treatment groups. The rates of positive responses (defined as a trough sitting diastolic BP of <90 mm Hg or a decrease in BP of > or =10 mm Hg) were also similar (approximately 60%) in the once- and twice-daily candesartan cilexetil groups. Furthermore, placebo-corrected trough-to-peak ratios for sitting diastolic BP exceeded 75% for both candesartan cilexetil regimens, indicating a persistent 24-hour duration of drug effect. Ambulatory BP monitoring performed in a subset of patients (n = 44) confirmed the consistent 24-hour BP-lowering effect and preservation of diurnal variation with once-daily dosing. No significant between-group differences were observed in the incidence or severity of clinical or laboratory adverse events. The results of this study suggest that identical daily doses of candesartan cilexetil administered once or twice daily have comparable efficacy and tolerability and that no additional clinical benefit is derived from twice-daily administration.

Take it to heart: a national health screening and education project in African-American communities. A joint project of the NMA and Bayer Corporation.

"Take It to Heart" is a community health screening and education project jointly sponsored by the National Medical Association (NMA) and Bayer Corporation, Pharmaceutical Division. The project was designed to increase awareness of the prevalence of hypertension and the risks of coronary heart disease in the African-American community. Free health testing for hypertension and cholesterol was provided in six communities. Participants received an individualized coronary risk assessment outlining key risk areas, followed by consultation with an NMA physician. A total of 1651 individuals between the ages of 18 and 82 participated in the health screenings. Ninety-five percent of those tested were African American. In a preliminary health history, 76% reported insufficient exercise, 23% reported a history of high blood pressure, and 19% had a positive family history of early cardiovascular disease. Screening test results revealed 40% of participants had a blood pressure > 140/90 mmHg, 52% had a cholesterol level > 200 mg, and 42% had a body mass index > 27. Based on these results, more than 76% were calculated to have a moderate to high coronary risk profile. Hypertension and cardiovascular disease are major public health problems associated with an increased incidence of death in the African-American community. The Take It to Heart Project is an important mechanism of providing health information to the public and encouraging those at highest risk to take steps to improve their health status.