Candesartan improves maximal exercise capacity in hypertensives: results of a randomized placebo-controlled crossover trial.

Cardiac hypertrophy and remodelling in hypertension has been associated with impaired exercise capacity. The authors tested whether an angiotensin receptor blocker, candesartan, improved exercise peak oxygen volume (VO2) in this population. A total of 154 untreated hypertensive patients, aged 40 to 66 years, with World Health Organization stage I or II hypertension and left ventricular hypertrophy, were randomized to receive placebo, candesartan (32 mg), each of these plus aspirin (300 mg/d), or the same preparations in a reverse order, for 3 weeks, with a 3-week washout period between treatments. The authors measured maximal workload and oxygen reserve with an exercise test, 24 hour-ambulatory blood pressure, and echocardiography at the end of each treatment. Hypertensive patients did not achieve the maximal workload (116 [99-133] W vs 132 (AMA style = no period on vs) [116-149] W; P=.01). This impaired exercise capacity was in a multiple regression analysis related to lower oxygen reserve (r=0.49, P<.001), and the lower oxygen reserve to higher left ventricular hypertrophy by echocardiography (beta=-0.34), respectively. The use of candesartan alone or with aspirin resulted in an improvement of peak VO2 and exercise tolerance, when compared with controls. Patients with hypertension and cardiac hypertrophy cannot achieve a predicted maximal workload. The use of an angiotensin receptor blocker in therapy may represent a useful treatment in these patients for its effect on exercise peak VO2 and exercise tolerance. The use of aspirin did not affect outcome.