A systematic review and meta-analysis of candesartan and losartan in the management of essential hypertension

BACKGROUND: Candesartan is a relatively novel antihypertensive agent of the angiotensin receptor blocker (ARB). Several clinical trials have compared candesartan with losartan in the management of essential hypertension. However, systematic assessment of efficacy and safety between candesartan and losartan is still lacking. METHODS: We reviewed randomised controlled trials (RCTs) comparing candesartan with losartan for net reduction in blood pressure from baseline, response and control rates, and incidences of common and serious adverse events.Weighted mean differences (WMD), and relative risk (RR) with 95% confidence intervals (CI) were calculated for continuous and dichotomous data, respectively. RESULTS: A total of 12 RCTs with 3644 patients were included in this meta-analysis. When comparing the efficacy of candesartan and losartan in reducing systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the end of the follow-up period, results with candesartan were superior to losartan in the reduction SBP and DBP (WMD, -2.97; 95% CI, -4.18 - -1.77; p < 0.001; WMD, -1.76; 95% CI, -2.57 - -0.96; p < 0.001; respectively). Candesartan had better response and control rates than losartan. (RR, 1.12; 95% CI, 1.06-1.18; p < 0.01; RR, 1.26; 95% CI, 1.06-1.50; p = 0.008). Reported common adverse events for the two agents were not significantly different (RR, 0.98; 95% CI, 0.86-1.12; p = 0.78). The incidence of serious adverse events for candesartan was lower than for losartan (RR, 0.48; 95% CI, 0.25-0.92; p = 0.03). The net reduction of DBP showed negative correlation with baseline DBP in both candesartan and losartan groups (regression coefficient -1.81, p = 0.03 and regression coefficient -1.56, p = 0.02, respectively). CONCLUSIONS: Candesartan is superior to losartan in reducing blood pressure. Candesartan also causes fewer serious adverse events than losartan.