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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EResults from animal models have shown that hypertension can be regressed to normal blood pressure (BP) levels [Smallegange C et al. \u003Cem\u003EHypertension\u003C\/em\u003E 2004] and that this reduction can be maintained after pulse treatment with an angiotensin receptor blocker [Ishiguro K et al. \u003Cem\u003EHypertension\u003C\/em\u003E 2009]. The Short Treatment with Angiotensin Receptor Blocker Candesartan Surveyed by Telemedicine study [STAR CAST; Sasamura H. \u003Cem\u003EHypertens Res\u003C\/em\u003E 2008; UMIN-CTR UMIN000000941] tested the feasibility of regressing hypertension in humans.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EResults from animal models have shown that hypertension can be regressed to normal blood pressure (BP) levels [Smallegange C et al. \u003Cem\u003EHypertension\u003C\/em\u003E 2004] and that this reduction can be maintained after pulse treatment with an angiotensin receptor blocker [Ishiguro K et al. \u003Cem\u003EHypertension\u003C\/em\u003E 2009]. The Short Treatment With Angiotensin Receptor Blocker Candesartan Surveyed by Telemedicine study [STAR CAST; Sasamura H. \u003Cem\u003EHypertens Res\u003C\/em\u003E 2008; UMINCTR UMIN000000941] tested the feasibility of regressing hypertension in humans. Hiroyuki Sasamura, MD, PhD, Keio University, Tokyo, Japan, presented the preliminary results.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn this prospective, randomized, open-label, blinded-endpoint study, 124 patients were randomized to candesartan 4 to 12 mg daily and 120 patients to nifedipine controlled release (CR) 10 to 40 mg daily for a 12-month active treatment period. Trichlormethiazide 2 mg daily was added to reach target BP levels after maximizing active treatment. During the subsequent 13-month withdrawal phase, the active treatment was reduced according to a predefined dosing schedule, and surveillance conducted using a telemedicine system that transferred home BP readings real-time to the research center.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe patients were young (mean age, 51; range, 30 to 59 years), with a family history of hypertension (within 2 degrees of consanguinity), and had been recently diagnosed with Grade 1 hypertension (systolic BP [SBP] 140 to 159 mm Hg and\/or diastolic BP [DBP] 90 to 99 mm Hg on two consecutive occasions). The patients had not taken antihypertensive medication during the 3 months preceding the study and had provided informed consent. Most patients were men (60.5% and 65.8% of the candesartan and nifedipine CR groups, respectively). The baseline BP was 152\/91 mm Hg.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe End BP was defined as an office SBP \u2265140 mm Hg and\/or \u226590 mm Hg at two consecutive visits; office SBP \u2265160 mm Hg and\/or DBP \u2265100 mm Hg at any one visit; mean weekly home SBP \u2265140 mm Hg and\/or DBP \u226590 mm Hg for 2 consecutive weeks; or mean weekly SBP \u2265160 mm Hg and\/or DBP \u2265100 mm Hg at any 1 week.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe office and home BP levels were significantly and similarly reduced below target levels with both candesartan and nifedipine CR.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe primary endpoint was the antihypertensive drug withdrawal success rate, defined as the proportion of patients who discontinued active treatment but did not reach End BP and did not restart antihypertensive treatment. All patients, except one in the candesartan arm, reached the End BP within 1 year. The Kaplan-Meier curve revealed a statistically significant difference in the candesartan arm compared with the nifedipine CR arm (log-rank p=0.0001).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe probability of not reaching the End BP was significantly higher in the candesartan arm at 1 month (RR, 1.874; 95% CI, 1.283 to 2.736; p=0.0008) and 3 months (RR, 9.080; 95% CI, 1.169 to 70.497; p=0.0099) after starting drug withdrawal compared with nifedipine CR. For the secondary endpoint of median duration of drug withdrawal, no significant difference was found (candesartan arm, 27 days [range, 27 to 34 days]; nifedipine CR arm, 27 days [range, 26 to 27 days]).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe withdrawal of candesartan was associated with a small but significantly longer delay before restarting antihypertensive medication compared with nifedipine CR, which was statistically significant for office SBP (p=0.003).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe standard doses of active treatment were not associated with regression of hypertension. Further studies with larger doses of candesartan for a longer time may be warranted to evaluate whether a sustainable and clinically relevant reversal of hypertension can be obtained and its natural history altered.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/9\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznue1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}