Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate.

Early morning hypertension and a high heart rate are risk factors for cardiovascular disease. The DOHSAM study was designed to evaluate the effect of candesartan on early morning blood pressure (BP) and heart rate in hypertensives. We used a prospective, randomized, open-label design. Protocol 1: Patients with early morning BP more than 135/85 mmHg who were not on any antihypertensive drug or on candesartan were given amlodipine 2.5 mg/day (amlodipine group, n = 22) or added candesartan 4 mg/day (candesartan group, n = 36). Candesartan or amlodipine was added when BP did not fall lower than 135/85 mmHg. Protocol 2: Early morning hypertensives who were on other angiotensin receptor blockers (ARBs) (n = 50) such as valsartan, losartan, telmisartan and olmesartan were switched to candesartan. Early morning BP significantly decreased in the candesartan group compared with the amlodipine group 9 and 12 months after treatment. Switching other ARBs except for olmesartan to candesartan significantly decreased early morning systolic and diastolic BP 3, 6, 9 and 12 months after treatment. Heart rate in the office significantly decreased by switching to candesartan 6, 9 and 12 months after treatment. In conclusion, candesartan significantly decreased early morning hypertension more than amlodipine or other ARBs except olmesartan in early morning hypertensives.

Relationship between serum albumin level and aging in community-dwelling self-supported elderly population.

While lower serum albumin concentration is often found in the elderly, a relation between serum albumin and age has not been fully elucidated. We conducted population-based cross-sectional and 5-y longitudinal study to examine the relation. A total of 22,705 male and 40,149 female, aged 65 y and older, living in Gifu, participated in the health check service conducted by Gifu City Medical Association. They were self-supported in the activity of daily living and 3,438 of them were followed up every year from 1999 to 2003. Serum albumin levels decreased with age in both men and women. In the cross-sectional study, median value declined from 4.3 g/dL in males aged 65-69 y to 3.9 g/dL in 90< or = y, and 4.3 g/dL to 4.0 g/dL in females. Incidence of hypoalbuminemia (serum albumin < or =3.5 g/dL) increased in parallel with age from 1.2% (65-69 y) to 6.6% (85-89) in males, and 0.6% to 4.1% in females. In the longitudinal study, regression analysis showed a significant decline in serum albumin of 0.015 g/dL per year (r= -0.716) in males, and 0.012 g/ dL per year (r= -0.794) in females. Relative reduction of serum albumin in 5 y was larger in advanced age; 1.2% in females aged 65-69 y and 3.1% in 85-89 y (p<0.05), but not in males. In conclusion, a fall in serum albumin concentration in community-dwelling, self-supported elderly persons was associated significantly with aging.