Effects of candesartan cilexetil and enalapril on inflammatory markers of atherosclerosis in hypertensive patients with non-insulin-dependent diabetes mellitus.

Circulating adhesion molecules may have a
prognostic significance as markers of endothelial damage.
Drugs which inhibit the renin–angiotensin system may be
effective in reducing circulating or tissue adhesion
molecules, albeit data available are scarce. The aim of the
study was to investigate the effects of an angiotensinconverting
enzyme (ACE) inhibitor, enalapril and a highly
selective angiotensin receptor blocker, candesartan
cilexetil, on circulating adhesion molecules in a large
sample of patients with non-insulin-dependent diabetes
mellitus (NIDDM). The study was comparative, multicenter,
randomized and double blind, with two parallel groups.
Patients and methods NIDDM patients with a diagnosis of
mild (grade 1) essential hypertension were included in the
study, at the end of a 2-week placebo run-in period. The
primary end-point of the study was to evaluate changes of
intercellular adhesion molecule-1 (ICAM-1) plasma levels
during treatment. The secondary end-points were: changes
in vascular cells adhesion molecule-1 (VCAM-1), von
Willebrand factor (vWF), fibrinogen and plasminogen
activator inhibitor-1 (PAI-1) circulating levels and of urinary
albumin excretion rate (AER) as well; 129 patients were
randomized: 66 in the candesartan group and 63 in the
enalapril group, 118 of them completed the scheduled
24-week treatment period.
Results Candesartan and enalapril equally reduced
circulating level of ICAM-1 and exerted comparable effects
on changes of other adhesion molecules and coagulation
factors. A similar blood pressure-lowering effect
was observed with the two drugs (candesartan: from
148/90 W 11/8 to 132/82 W 12/7 mmHg, P < 0.01,
enalapril: from 148/91 W 12/8 to 131/85 W 14/6 mmHg,
P < 0.01). Candesartan was more effective than enalapril
in the reduction of albuminuria (P < 0.05 between
treatments), although urinary protein excretion can be
considered normal in the majority of patients. The two
drugs were comparable in terms of adverse events
reported.
Conclusion Candesartan and enalapril showed similar
effects on blood pressure and on circulating adhesion
molecules. In this study urinary protein excretion was
reduced more by candesartan.