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Candesartan reduces the progression of eGFR in hypertension patients

Background and purpose：Recently the demand for dialysis and kidney transplantation from chronic kidney disease（CKD）has increased. However, the ratio of patients with CKD, which causes cardiovascular disease（CVD）, is greater than the ratio of those that progress to end stage renal disease（ESRD）. This study investigated whether candesartan reduced the progression of CKD. Methods：This study investigated the background factors, such as the type of antihypertensive agents, blood pressure（BP）and body mass index（BMI）for 119 essential hypertensive outpatients who took candesartan for more than one year. The patients were classified into stages following the CKD stage classification using the revised estimated glomerular filtration rate（GFR）. Results：There was progression to CKD stage 3 in all subjects and the ratio of the subjects achieving their target BP by using candesartan significantly improved from 25.2％ to 68.9％. The ratio of it with CKD stage 3 also improved significantly from 8.8％ to 44.1％. The average eGFR showed no significant change over 4 years following admission. When the subjects were classified by the CKD stage, the ratio of achieving a systolic BP ＜130 mmHg by the use of candesartan rose significantly from 15.4％ to 61.5％ in improving CKD stage group. The improving CKD stage group had a higher BMI. The eGFR improved significantly from 53.8 mL／min／1.73 m2 to 59.4 mL／min／1.73 m2 in the subjects with CKD stage 3 over 3 years and the majority of these patients took the maximum dose（12 mg）.Conclusions：This analysis confirmed that angiotensin I I receptor blocker（ARB）was necessary and high dose ARB was important for renoprotection. Furthermore, renoprotective effects were expected in the cases that strictly achieved at the target BP and in the cases of higher BMI.