I. Atacand Fact File
Atacand was introduced by Astra-Zeneca pharmaceuticals.
Globally, Astra-Zeneca is one of the world's leading pharmaceutical companies with 60,000 people - 12,000 in the US alone - dedicated to the discovery, development, and marketing of new pharmaceutical solutions, to enrich the quality of people's lives all over the world.
The focused areas of research include:
- Cardiovascular
- Gastrointestinal
- Infection
- Neuroscience
- Oncology
- Respiratory
II. Atacand Medication
Atacand was first launched for hypertension in 1997 and is currently approved and marketed in over 70 countries around the world. In 2004 Atacand received the first approval for the treatment of CHF (Chronic Heart Failure) in patients with left ventricular systolic dysfunction.
Atacand (candesartan cilexetil) is an angiotensin receptor blocker (ARB), indicated for the treatment of patients with hypertension and patients with chronic heart failure (CHF) and left ventricular systolic dysfunction.
Atacand acts on the renin-angiotensin system (RAS), which plays an important role in regulating blood pressure. Angiotensin II, the main effector hormone in the RAS, mediates a wide range of responses such as vasoconstriction, sodium and fluid retention, cell growth, and sympathetic activation. Atacand binds to the AT1-receptor thereby blocking its interaction with angiotensin II. This blockade leads to vasodilatation and a decrease in blood pressure. Atacand is at least as effective as other antihypertensive drugs but with the advantage of the better tolerability profile associated with ARBs. The ARBs is the newest class of antihypertensives.
The benefits of Atacand in hypertension are well documented from several trials comparing Atacand with placebo, other ARBs (such as losartan) and other antihypertensive medications. Additional trials have investigated the effect of Atacand in reducing left ventricular hypertrophy (the CATCH study), reducing cardiovascular complications and dementia (the SCOPE study), and the impact on metabolic variables (the ALPINE study).
Antihypertensives: Information
Antihypertensives include:
- Diuretics ("water pills")
- Beta Blockers
- Alpha Blockers
- Alpha-Beta Blockers
- Sympathetic Nerve Inhibitors
- Angiotensin Converting Enzyme (ACE) Inhibitors
- Calcium Channel Blockers
- Angiotensin Receptor Blockers (formal medical name angiotensin-2-receptor antagonists, known as "sartans" for short). These agents are sometimes prescribed together, for instance an ACE inhibitor along with a calcium channel blocker.
In general, antihypertensives work through one or more of the following mechanisms:
- By Decreasing Blood Volume
- By Opening Up Blood Vessels, either by
- Inhibiting Constriction (narrowing) or
- Stimulating Dilation (widening), to make it easier for blood to flow through the arteries
- By Decreasing Rate and/or Force of Contraction of the Heart, thus decreasing the amount of blood pumped through the arteries
Angiotensin receptor blockers/sartans control blood pressure by blocking the action of angiotensin.
Common sartans include:
- Candesartan (Atacand)
- Eprosartan (Tevetem)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Telmisartan (Micardis)
- Valsartan (Diovan)
Angiotensin Receptor Blockers: Information
Angiotensin is a chemical that your body creates. Angiotensin is a chemical that your body naturally uses to maintain a constant blood pressure.
If your blood pressure suddenly became too low, you could get a stroke. Also, adequate blood pressure is necessary for the kidneys to do their job of filtering out the blood of waste products and toxic compounds.
Angiotensin is used by the human body as a blood pressure elevator. Angiotensin acts as a powerful vasoconstrictor (it causes your blood vessels to tighten up thereby reducing their inner diameter).
Angiotensin receptor blockers form a protective shield on the blood vessels so that the angiotensin's ability to tighten up your blood vessels is reduced. If the angiotensin cannot do this, the blood vessels remain in a relaxed state and blood pressure remains low.
Unlike the ACE inhibitors, angiotensin blockers do not cause a cough as a side effect. These are often substituted for ACE inhibitors when a cough develops in someone who is otherwise benefiting from the ACE inhibitor. They can either help or adversely affect kidney function and raise the potassium level just as ACE inhibitors may do. They have an anti-inflammatory effect on the walls of the blood vessels.
If you take an angiotensin II receptor blocker:
- You are less likely to have to go to hospital because of heart failure
- You are less likely to die of heart failure. The evidence for this is not as strong as it is for ACE inhibitors.
Hypertension (High Blood Pressure): Information
Approximately 50 million Americans aged 6 and older have elevated blood pressure (hypertension). In approximately 15% of these patients, a specific cause (i.e., Cushing's disease) can be identified: the remainder are said to have primary (essential) hypertension.
Diagram: Blood Pressure
Diagram: Hypertension
High blood pressure, sometimes called hypertension, means high pressure (tension) in the arteries. It does not mean excess emotional stress, though doctors' believe that stress might contribute to high blood pressure over a longer period of time.
Your blood pressure rises and falls with each heartbeat, even normal blood pressure does this. These levels can change with everyday activity, for example, during exercise or when you are asleep and this is also normal.
However, in some people, and as we get older, these changes in blood pressure start to happen at higher pressure levels than normal and this is what high blood pressure means.
Your blood pressure is usually measured with a blood pressure cuff placed around the upper arm that registers the pressure in units called millimeters of mercury (or mm Hg).
Your blood pressure is usually considered to be high when it is at a level exceeding 140/90 mm Hg (“140 over 90”) on several readings under various conditions. However, defining normal and abnormal is not always so clear-cut and your doctor or healthcare professional will make the necessary recommendations.
Blood pressure rises and falls with each heartbeat. Systolic blood pressure, the higher number, represents the pressure in the arteries as the heart contracts and sends blood into the circulation.
Diastolic pressure, the lower number, occurs as the heart relaxes following a beat. It represents the lowest pressure to which the arteries are exposed between heartbeats.
High blood pressure may be present for several years before it is detected and is often found during a routine check-up, for example, for insurance purposes. Usually there are no symptoms and consequences may only become apparent after many years.
Doctors know that there is a benefit from treating high blood pressure at any age, even in older patients of 65 years and over. Depending on the level of the blood pressure, different things are recommended. In some people with only mild elevations in blood pressure a change in diet and adopting a healthier lifestyle may reduce the blood pressure to normal. Your healthcare professional will provide you with the right diet for you. Its not just lowering the amount of salt you eat, although this is important: there are other things you can change in your diet that can help.
Also, if you are overweight, getting slimmer may help.
If necessary, high blood pressure can be treated with a range of different medicines, including:
- Beta-blockers, which make the heart beat more slowly and less strongly. They work by blocking the action of nerves supplying the heart that release a chemical called noradrenaline. This helps to control the rhythm and force of heart muscle movement. They also block a hormone called adrenaline (a chemical carried in the blood), which is similar to noradrenaline.
- Diuretics, which work in the kidneys to make you pass urine more often and get rid of excess fluid.
- Calcium-channel blockers, which relax arterial blood vessels making them less narrow. These lower the resistance to blood flow, allowing blood to flow more easily. They work by preventing calcium from entering the muscles in blood vessels because calcium is important in narrowing down blood vessels.
- ACE inhibitors and angiotensin II antagonists, which in general relax the blood vessels. They do this by preventing a hormone called angiotensin II from working, either by preventing its production or blocking its action. Like other hormones, angiotensin II is an active chemical signal in the blood. It controls the function of many organs or systems including the narrowing of blood vessels and prevents the kidneys from getting rid of excess fluid. Doctors believe that angiotensin II is involved as one of the causes of high blood pressure.
It is also important to follow any lifestyle instructions that your doctor has given to you, like trying to give up smoking, reducing your weight, doing more exercise and eating a healthy diet. When these and other risk factors are present together with high blood pressure, then this means there is even higher risk of serious disease.
It is also important to continue taking any medications you have been given, even if you feel normal.
No specific cause is found in 95% of patients with hypertension – this is called primary hypertension or sometimes essential-hypertension.
Most patients have primary, or essential hypertension. Most cases of primary hypertension are due to increased stiffness and narrowing of the smaller (peripheral) arteries.
This results in increased resistance to the flow of blood and is what makes the blood pressure go up.
Increased peripheral artery resistance is associated with genetics (family history), obesity, lack of exercise, over use of salt, and the natural ageing process.
A few patients have high blood pressure with a known cause (secondary hypertension). Long-lasting (chronic) kidney disease accounts for most of these patients where there is excessive fluid accumulation in the body that raises blood pressure. Hypertension can also occur during some pregnancies.
Side Effects of Antihypertensives
Note: Decreased blood pressure in a mother also has the potential to harm her developing baby. Since blood volume determines the amount of blood filtered/urine processed by the kidneys, antihypertensives have effects on that organ as well. Although in general blood-pressure-lowering medicines reduce strain on the kidney, some antihypertensives like sartans can nevertheless worsen kidney disease.
- Another major concern with hypertensives is that they can aggravate congestive heart failure.
As with most any drug, blood-pressure-lowering medications can have milder side effects as well. While on an antihypertensive, report any changes in your condition to your health care provider.
Side Effects of Angiotensin Receptor Blockers
- Low blood pressure is the most common side effect with angiotensin II receptor blockers. ARBs can also worsen kidney function and raise potassium levels.
- Dizziness, lightheadedness or faintness upon rising: This side effect may be strongest after the first dose, especially if you have been taking a diuretic (water pill). Get up more slowly. Contact your doctor if these symptoms are persistent or severe.
- Physical problems: Diarrhea, muscle cramps or weakness, back or leg pain, insomnia (difficulty sleeping), irregular heartbeat, or fast or slow heartbeat, sinusitis or upper respiratory infection. Contact your doctor if these symptoms are persistent or severe.
- Confusion: Contact your doctor right away.
- Severe vomiting or diarrhea: If you become sick with severe vomiting or diarrhea you may become dehydrated, which can lead to low blood pressure. Contact your doctor.
Alternate uses of Angiotensin Receptor Blockers
Angiotensin receptor blockers (ARB's) are primarily used to treat high blood pressure. However there is a growing body of evidence that these drugs are useful in the treatment of other cardiac diseases such as stroke and heart attack.
They also seem to have a beneficial effect on the kidney, particularly the kidneys of people with diabetes.
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III. Useful links
Government http://www.cdc.gov/
http://www.fda.gov/
http://www.fda.gov/cder/ogd/
http://www.nih.gov/
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
http://www.health.gov.on.ca/
National Library of Medicine
World Health Organization
Health Sites
http://www.mayoclinic.com/index.cfm
MedicineNet.com
Drugdigest.org
Healthsquare.com
http://www.atacand.com/50689_50808.aspx?l1=2
http://www.healthyhearts.com/angiotensinblockers.htm
http://lysine.pharm.utah.edu/netpharm/netpharm_00/notes/antihypertensives.html#Introduction
http://www.patienthealthinternational.com/article/501305.aspx
http://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/cardiovascular/antihypertensives.html
http://my.webmd.com/content/pages/9/1675_57812.htm
http://www.coreynahman.com/Angiotensinreceptorblockers_ARBs.html Pharmacy sites
http://www.roche.com/home/company/com_hist.htm
http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php
http://www.hsforum.com/stories/storyReader$1509
http://www.hsforum.com/stories/storyReader$1504
http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting
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