Relation between cardiovascular complications and blood pressure/blood glucose control in diabetic patients with hypertension receiving long-term candesartan cilexetil therapy: Challenge-DM study

AimTo investigate the relation between cardiovascular events and blood pressure or blood glucose control during long-term treatment with candesartan cilexetil in Japanese patients with hypertension and diabetes mellitus.MethodsDuring a planned 3-year follow-up period, five surveys were performed (at registration, after 6 months, and after 1–3 years).ResultsAmong 17,622 patients registered nationwide, 16,869 were available for safety evaluation and 16,860 for efficacy evaluation. The actual mean follow-up period was 29 months, and the annual incidence of primary cardiovascular events was 17.4/1000 persons. After 3 years, 18.0% of the patients had a blood pressure <130/80 mmHg, while 45.4% had a hemoglobin A1c <6.5%. Compared with these patients showing good control of hypertension and/or diabetes, the incidence of cardiovascular events was significantly higher in patients with poor control.ConclusionThese findings emphasize the importance of tight blood pressure and glycemic control in hypertensive patients with diabetes. In addition, the target blood pressure (<130/80 mmHg) in the 2004 Japanese Hypertension Management Guidelines and the target hemoglobin A1c (<6.5%) in the Japanese Treatment Guide for Diabetes were supported.