Improving prognosis in hypertension: exploring the benefits of angiotensin II type 1 receptor blockade.

Prognosis can be improved in hypertensive patients not only by reducing blood pressure, but probably also by effective suppression of adverse neurohormonal influences. Inhibition of the renin-angiotensin system by angiotensin-converting enzyme inhibitors effectively reduces left ventricular hypertrophy and decreases morbidity and mortality due to heart failure, as well as slowing the progression of renal disease. Initial data from studies of angiotensin II type 1 (AT1) receptor blockers indicate that these agents should also be effective in reducing cardiac and renal damage. In this class, candesartan, by virtue of its tight and long-lasting binding to the AT1-receptor, provides pronounced 24-h blood pressure control with effective blockade of all the major negative cardiovascular effects of angiotensin II. Candesartan cilexetil has also been shown to be effective and well tolerated in combination with hydrochlorothiazide in those hypertensive patients who require more than one agent to reach their target blood pressure.