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Monitor for pealmia ttaeree loom or tae metabole a rature Kesporng”soronlacone25-Sng amierideS0mg.tmterene Most eflecve when compe ACE tome Strengerclncal dence wctortaione furosemide 200mg tice dy, tre mie 140mg [Rap duets may be needed when GR AOL min sceyan AcE nope, eras ono and qin 040mg, raiprs-__SE:Cogh (ACE an, angioedema ore WAH ACE, mg, wand 2am pera Ata canesanan 83 vara 0320rg ose O60, (Sinan owes wc oe canes ‘mesaan 200mg tartan 200mg prevent mgraneheadachee ete ecars _metoprcl suecate 0D nd tatrate 0-10 ce iy, Not fat ine gets rece a poet CHE ‘rebwol 510mg preprarcel 4-120 wie aly coresil625-25mg Cause fatigue an dereased Neat te (wc day Beoprat-bme abet 100-20 ce ly ever core: mast nypgheemic arent Calcumctannel Oops: sniodgine5-10me seine ER3D-me Cae ede: yronyiines may be sey combined Socer: Nominees: atearem CF380360 mg verapra60.120"g3 w/ 8tcer "ies yor 200 80rg Non-dtndropynes eds heartrae and proteinuria Vesoatatrs —_hyéralaine 2-100mgtwie day minos 10% ytaasne nd mini may aie res tary etenton = sua requre ureter Ske terion 15a dorzosn Img gen atbetine pne-blockers may ase ortostachyptensien Carrying clndne 0.14.24 ce dally, methyldopa 250500mg twice aly Conde salable wee pte formalin fr nes ressintnypertesionstoop rREssuRe 2000; 9 (Suppl I): 56 Poster abstracts ABSTRACT Candesartan Cilexetil is not Associated with Cough in Patients with Enalapril- induced Cough P. TANSER,' L. M. CAMPBELL.” J. CARRANZA,’ J. KARRASCH.! P. TOUTOUZAS® AND R. WATTS® From he '¢ Joseph's Hopital, Hamilton, Canada, “South Bank Surgery, Kirkintilloch, UK, °Honpital Genera Dr Miguel Siva Morelia, Mexico. "Peninsula Specialist Centre. Kipp Ring. Australia. “Carlogcal University Ci, Mppokration Hsp, thes Greece and "The Investigator Cini, Port Lincoln, Australi ‘Tanser P, Campbell LM, Carranza J, Karrasch J, Toutouzas P, Watts R. Candesartan cilexetil isnot associated with cough in patients with enatapriinduced cough. Blood Pressure 2000: 9 (Suppl 1): 56 (abst, ‘Treatment with angitensn-convering enzyine (ACE) inhibitors is fequemly associated with persistent dy cough. Ths side elec is thought to be de to the non-specific action of ACE inhibitors, which, in axkition to suppressing the renin-angiotensin system (RAS), leads to the accumulation of kinins, ncephalins and other bologically active peptides, Candesartan cilexetil isa new, long-acting angiotensin Type 1 (AT) receptor blocker, which offers « more specific means of suppressing the RAS than can be achieved with ACE iahibitors. in this study, we compared the incidence and severity of cough during treatment with candesartan ilxetil, enalapril and placebo in patents with bypertension and enalapril induced cough. Men and women, aged 20-80 year, with & history of medically tweated primary hypertension and ACE-inhibior elated cough were enrolled. The presence of cough was confirmed ring 2 A-weck challenge period with enalapril, 10mg, which abuted during a subsequent 4-weck ‘washout period. with plsccbo. Patents with confinned ACE-inhibitorelated cough were then fandomized to double-lind teatment with candesartan cilexetl, Smg once daily (n= 62), enalapril, Omg once daily (n =66), oF placebo (1=26). Baseline Blood pressure was sini in all groups. Although blood pressure'was fecorded during the sdy, this was for safety monitoring, and the ‘measurements were not standardized in relation to study drug intake or time of dy. The frequency of dry cough was recorded ona visual analogue scale (VAS), For each assesment, patients marked a cross on Straight horizontal 100 mm line, rating cough frequency from "none ofthe ie” atone endothe line to “all of the time” at the other end. The impact of treatment on quality of life was also stadie, using the Syinpiom Assessient (SA) questionnaire and the Minor Symptom Evahiation (MSE) profile. The SA ‘questionnaire assessed the severity of nine symptoms, inclding dry cough, by means ofa five-graded Tikert scale (ota all i, moderately quite abt extremely). Changes inthe thee dimension ofthe MSE profile ~ contentment, vitality and sleep ~ were recorded using a VAS, Candesartan clenstil was Superior to enalapril regarding the change in frequency (p= 0001) and severity (p < 0001) of dy cough Aer § weeks of treatment, the proportions of patients with cough were 26.9% for placebo, 355% for ‘andsartancilexeti and 682% for enalapril (p< 0001, candesartan cilxetil versus enalapitp > 0.20, ‘andesartancilexetil vers placebo). Treatment wih candesartan cilexei didnot compromise patients” well-being. Compared with placebo, candesartan cileetil was superior in terms of il effect on Contentment: similar trends were noted for vitality and slep, although the differences wore not significant. When all adverse evens were considered, candesartan clestl was very wel tolerated. No Setious adverse events occured inthe candesartan clexetil or placebo group, while thre patients inthe enalapril group reported serious adverse evens (chest pain, agranulocytons, acidenal fracture). NO treatment related changes of clinical relevance could be found wilh regard to laboratory variables, ECG ‘or vital signsphysical findings, except the anticipated blood pressure reduction inthe active treatment "soups In conesion, candesartan clexe i not associated with cough in hypertensive patents with previous ACE-inhibitorinduced cough, The incidence of dry cough in patients treated with candesartan ‘lexi was simile to hat of placebo and lower than that of enalape