Sartans in the treatment of arterial hypertension: benefits of candesartan
Objective. To present a scientific review on the clinical pharmacology of angiotensin AT II receptor blockers (sartans), in particular the pharmacological and clinical features of candesartan. Materials and Methods. Domestic and foreign publications were searched in Russian and international search engines (PubMed, eLibrary, etc.) since 1999 to write this review. Results. In recent years, AT II receptor blockers, or sartans, have been widely used to treat arterial hypertension. Despite the common characteristics of this class of antihypertensive drugs, such as mechanism of action, possibility of single daily administration, good tolerability, and minimal side effects, there are clinical and pharmacological differences between the drugs, which determine their effectiveness. It has been shown that candesartan differs in the kinetics of interaction with AT1-receptors, which provides a more pronounced hypotensive effect and a high trough/peak index of the hypotensive effect. Pharmacokinetics and hypotensive effect of candesartan do not depend on genetic polymorphism of metabolizing enzyme CYP2C9. Several meta-analyses have shown candesartan to be advantageous in terms of blood pressure (BP) reduction, providing it with BP-dependent benefits; in a large observational study, candesartan showed better cardiovascular outcomes for hypertension compared to losartan, demonstrating possible BP-independent clinical-pharmacological benefits. Currently, the cost of sartan treatment is becoming more affordable on the economic side due to the emergence of generic drugs. Among generics of candesartan a worthy place in our country belongs to Hyposart (manufacturer is pharmaceutical plant «Polpharma» SA, Poland), which has demonstrated bioequivalence to the original drug, which is important from the evidence-based medicine point of view. Conclusion. Candesartan is one of the most potent drugs of the class of AT II receptor blockers, which is confirmed by its clinical and pharmacological characteristics. A number of studies and meta-analyses have demonstrated hypotensive and long-term efficacy benefits, which are associated with BP-dependent and BP-independent effects due to the peculiarities of interaction with the receptors.