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CSM-1 Patients With and Without Obesity LSM Difference and 95% CI in BP (230, 231 Pooled) † -8-7-6-5-4-3-2012345678 Diastolic BP Overall (N = 1,191) Obese.

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Presentation on theme: "CSM-1 Patients With and Without Obesity LSM Difference and 95% CI in BP (230, 231 Pooled) † -8-7-6-5-4-3-2012345678 Diastolic BP Overall (N = 1,191) Obese."— Presentation transcript:

1 CSM-1 Patients With and Without Obesity LSM Difference and 95% CI in BP (230, 231 Pooled) † -8-7-6-5-4-3-2012345678 Diastolic BP Overall (N = 1,191) Obese (n = 650) Not obese (n = 537) Systolic BP Overall (N = 1,191) Obese (n = 650) Not obese (n = 537) Trough change from baseline at Wk 8, ITT Favors CCFavors losartan 14 CC = Candesartan cilexetil. Obese = BMI ≥ 30 kg/m 2. †Post hoc. ITT population.

2 CSM-2 Dose Related BP Reduction Mean Change in BP From Baseline at 8 Weeks Measured 24 hr postdose CC = Candesartan cilexetil. *p < 0.001 vs placebo (per protocol population). Note: p < 0.001 for dose response over the dose range studied, 2 mg to 32 mg, for DBP and SBP. Adapted from Reif M, et al. Am J Cardiol. 1998;82:961-965. * * * * * * 14

3 CSM-3 Comparison of Antihypertensive Efficacy of Candesartan Cilexetil and Losartan Study Design (175) 1 Gradman AH, et al. Heart Disease. 1999;1:52-57. CSR 175 Fig 1 100 mg 50 mg Placebo run-in 32 mg 16 mg 04 weeks8 weeks Losartan Candesartan cilexetil RAN RRAANNDODOMMIIZZEEDDRRAANNDODOMMIIZZEEDDMIZED Randomized, double-blind, multicenter, titration-to-effect, parallel-group design

4 CSM-4 Least Squares Mean Change From Baseline to Week 8: Once-daily vs Twice-daily Candesartan Cilexetil (116) (n = 90)(n = 93)(n = 91) *p < 0.001 versus placebo for each treatment. Zuschke C et al. Clin Ther. 1999; 21:464-474. * * * * p = NS 15

5 CSM-5 Mean Change in Trough Diastolic Blood Pressure from Baseline to Week 4 (Weber) -12 -10 -8 -6 -4 -2 0 2 Placebo (n = 30) Losartan 50 mg QD (n = 29) Losartan 100 mg QD (n = 28) Losartan 50 mg BID (n = 30) *p < 0.05 vs placebo ** p < 0.01 vs placebo 100.3100.0101.1101.4 Baseline DBP, mm Hg Weber MA, et al. Arch Intern Med. 1995;155:405-411. 17 * ** mm Hg

6 CSM-6 Patients With and Without Diabetes LSM Difference and 95% CI in BP (230, 231 Pooled) † -8-7-6-5-4-3-2012345678 Diastolic BP Overall (N = 1,191) Diabetes (n = 107) No diabetes (n = 1,084) Systolic BP Overall (N = 1,191) Diabetes (n = 107) No diabetes (n = 1,084) Trough change from baseline at Wk 8, ITT Favors CCFavors losartan 14 †Post hoc. ITT population. CC = Candesartan cilexetil.

7 CSM-7 Subpopulations Trough Diastolic Blood Pressure (230, 231) PopulationN  N  N  N  Overall284(–10.4)280(–9.0)321(–11.0)306(–8.9) Black57(–6.4) 52(–7.7)57(–8.2) 47(–6.6) Non-Black227(–11.4)228(–9.3)264(–11.6)259(–9.4) Age ≥ 65 yr58(–8.7) 50(–8.7) 52(–11.1) 47(–8.1) Age < 65 yr226(–10.9)230(–9.1)269(–11.0)259(–9.1) Female118(–11.1)121(–9.8)137(–11.3)127(–9.9) Male166(–9.9)159(–8.4)184(–10.9)179(–8.3) CC = Candesartan cilexetil. ITT population. CSR 230, 231 Table 26 C mm Hg Study 230Study 231 CCLosartanCCLosartan

8 CSM-8 Mean Change From Baseline to Week 8 in Diastolic Ambulatory Blood Pressure (CHAMP) Lacourcière Y & Asmar R for the Candesartan/Losartan Study Investigators. Am J Hypertens. 1999;12:1181-1187. 0 –2 –4 –6 –8 –10 –12 2 4 6 8 10 12141618202224262830323436 Time after dose, hr 2 Candesartan cilexetil 16 mg (n = 106) Losartan 100 mg (n = 100) Mean Change in DBP, mm Hg

9 CSM-9 Mean Change From Baseline to Week 8 in Systolic Ambulatory Blood Pressure (CHAMP ) Lacourcière Y & Asmar R for the Candesartan/Losartan Study Investigators. Am J Hypertens. 1999;12:1181-1187. 0 –2 –4 –6 –8 –10 –12 –14 –16 –18 2468 10 12141618202224262830323436 Candesartan cilexetil 16 mg (n = 106) Losartan 100 mg (n = 100) Time after dose, hr Mean Change in SBP, mm Hg 2

10 CSM-10 Change From Baseline for Serum Chemistry and Hematology Parameters in Randomized Patients Study 230 Study 231 ParameterCCLosartan CC Losartan ALAT, U/L 1.7 1.1 1.4 1.8 Alkaline phos, U/L 0.4 3.1 0.5 2.3 ASAT, U/L 1.1–0.7–0.7 0.1 Bilirubin total, mg/dL 0.0 0.0 0.0 0.0 Creatinine, mg/dL 0.0 0.0 0.0 0.0 Potassium, mEq/L 0.0 0.0 0.1 0.1 Urea nitrogen, mg/dL 0.8 0.8 0.8 0.5 Uric acid, mg/dL–0.1–0.6 0.0–0.5 HCT, %–0.5–0.3–0.2–0.2 Hb, g/dL–0.2–0.1–0.1–0.1 WBC, 10 3 /µL –0.1 0.1 0.1 0.1 1 CSR 230, 231 Table 32 CC = Candesartan cilexetil. Safety population.

11 CSM-11 Patient Compliance † (230) Compliant, n (%) Treatment< 90%≥ 90%Total, N Candesartan cilexetil 28 (9)279 (91)307 (100) Losartan17 (6)287 (94)304 (100) Total45 (7)566 (93) 611 (100) 7 †Based on tablet counts.

12 CSM-12 BP Determination Methods (230, 231) Patients: sitting for 5 minutes Sphygmomanometer: Hg column, appropriate cuff size at heart level, right arm Readings:Systolic = Korotkoff I Diastolic = Korotkoff V Determination Mean of 3 sequential readings ≥ 2 minutes apart with ≤ 5 mm Hg highest to lowest value Qualifying blood pressure: diastolic 95 to 114 mm Hg at Wk 3 and 4 (or 4 and 5) of placebo run-in period

13 CSM-13 Controlled Patients and Responders at Week 8 (Pooled) N = 639N = 625N = 639N = 625N = 639N = 625N = 639N = 625 Control DBP: DBP < 90 mm Hg; Control: SBP < 140 mm Hg; Control DBP and SBP: DBP < 90 mm Hg and SBP < 140 mm Hg; Responder: DBP < 90 mm Hg or DBP ≥ 10 mm Hg decrease. 19

14 CSM-14 Regulatory Precedent ZESTRIL ® /Prinivil ® Comparative Studies Lisinopril vs HCTZ vs lisinopril + HCTZ Multicenter, randomized, parallel, double-blind, titration-to-effect, 24 wk with extension 390 patients with mild to moderate HTN (DBP 90 to 120 mm Hg) Lisinopril 20 to 80 mg, HCTZ 12.5 to 50 mg or lisinopril 20 mg + HCTZ 12.5 to 80 mg + 50 mg Primary endpoint: mean reduction in diastolic BP Significant reductions in systolic and diastolic BP at Wk 12 and 24: HCTZ + lisinopril (–18.2 mm Hg) > lisinopril (–12.5 mm Hg) > HCTZ (–6.8 mm Hg) (p  0.01)


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