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Cited by 225Blood Pressure and Hypertension StudiesRenin-Angiotensin System StudiesHormonal Regulation and Hypertension

The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index.

Comparative effects of candesartan and hydrochlorothiazide on blood pressure, insulin sensitivity, and sympathetic drive in obese hypertensive individuals: results of the CROSS study

Grassi, Guido, Seravalle, Gino, Dell'Oro, Raffaella, Trevano, Fosca Quarti, Bombelli, Michele, Scopelliti, Francesco, Facchini, Anna, Mancia, Giuseppe·2003·Journal of Hypertension
DOI 10.1097/00004872-200309000-00027
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Abstract

OBJECTIVE: The increase in blood pressure that accompanies the obese state is almost invariably associated with alterations in metabolism (insulin resistance and dyslipidaemia) and the neurohumoral profile (activation of the renin-angiotensin system, sympathetic overactivity), which potentiate the cardiovascular risk associated with hypertension. However, debate remains as to the antihypertensive drug on which treatment of obesity-related hypertension should be based. The CROSS (Candesartan Role on Obesity and on Sympathetic System) study was undertaken to examine the antihypertensive, neuroadrenergic, and metabolic effects of an angiotensin II receptor blocker in comparison with a diuretic in obese hypertensive individuals. METHODS: In 127 obese hypertensive individuals aged 50.7 +/- 5.1 years (mean +/- SD), we measured clinic blood pressure, heart rate, plasma glucose, and insulin at rest and during an oral glucose load before and 12 weeks after treatment with either candesartan cilexetil (8-16 mg once daily) or hydrochlorothiazide (HCTZ, 25-50 mg once daily), administered orally in accordance with a double-blind, randomized, placebo-controlled, two-parallel-groups study design. Insulin sensitivity was expressed as insulin resistance index (IRI), calculated as the ratio of the area under the curve (AUC) for glucose to that for insulin. In a subgroup of patients, measurements also included direct microneurographic recording of muscle sympathetic nerve activity (MSNA) in the peroneal nerve. RESULTS: Candesartan cilexetil caused a significant (P < 0.01) reduction in both mean blood pressure (from 114.2 +/- 5.1 to 99.6 +/- 6.0 mmHg) and MSNA (from 51.0 +/- 12.3 to 40.4 +/- 12.5 bursts per 100 heart beats), and a significant (P < 0.02) increase in insulin sensitivity (AUC IRI: from -23.2 +/- 22.1 to -17.6 +/- 12.2). In contrast, HCTZ did not significantly affect MSNA and worsened insulin sensitivity, while achieving blood pressure reductions similar to those produced by candesartan cilexetil. CONCLUSIONS: These data provide evidence that, in obese hypertensive individuals, treatment with candesartan cilexetil has an antihypertensive effect similar to that of HCTZ. Unlike diuretic treatment, however, treatment with candesartan cilexetil improves insulin sensitivity and exerts sympathoinhibitory effects.

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Crossref · 10.1097/00004872-200309000-00027

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Citations

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Research works printed but not linked: 2

  1. 1998, Obes Res, 6, 71S
  2. Mancia, 1998, J Hypertens, 16, S35

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Metadata

Authors
Grassi, G., Seravalle, G., Dell'Oro, R., Trevano, F. Q., Bombelli, M., Scopelliti, F., Facchini, A., & Mancia, G.
Affiliations
  • IRCCS Istituto Auxologico Italiano (IT)
  • University of Milano-Bicocca (IT)
  • Azienda Ospedaliera San Gerardo (IT)
Corresponding author
Mancia, Giuseppe
ORCID
Venue
Journal of Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2003-09
Volume
21
Issue
9
Pages
1761-1769
ISSN
0263-6352 (ISSN-L)
DOI
10.1097/00004872-200309000-00027
OpenAlex
W2007653610
Cited by
225
References
40
Citations by year
2026: 2 · 2025: 8 · 2024: 4 · 2023: 9 · 2022: 2 · 2021: 5 · 2020: 4 · 2019: 8 · 2018: 2 · 2017: 9 · 2016: 10 · 2015: 12 · 2014: 13 · 2013: 5 · 2012: 12
FWCI
12.52
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • BOA (University of Milano-Bicocca) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords
candesartan cilexetil, hydrochlorothiazide, obesity-related hypertension, angiotensin receptor blockers, diuretics, insulin resistance, insulin sensitivity, muscle sympathetic nerve activity, sympathetic nervous system, blood pressure reduction, renin-angiotensin system, antihypertensive drug comparison, microneurography, oral glucose tolerance test
MeSH terms
Adolescent, Adult, Aged, Antihypertensive Agents, Benzimidazoles, Biphenyl Compounds, Blood Glucose, Blood Pressure, Female, Humans, Hydrochlorothiazide, Hypertension, Insulin Resistance, Male, Middle Aged, Obesity, Sympathetic Nervous System, Tetrazoles, Lipid Metabolism

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