Author(s): Mesi Leorita, Zullies Ikawati, Agung EndroNugroho, Ismail Setyopranoto

Email(s): zullies_ikawati@ugm.ac.id

DOI: 10.52711/0974-360X.2024.00238   

Address: Mesi Leorita1,2, Zullies Ikawati1*, Agung EndroNugroho1, Ismail Setyopranoto3
1Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia.
2Faculty of Pharmacy, University of Halu Oleo Kendari, Southeast Sulawesi, Indonesia.
3Department of Neurology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogjakarta.
*Corresponding Author

Published In:   Volume - 17,      Issue - 4,     Year - 2024


ABSTRACT:
There are differences in the efficacy of a drug between ethnicities. Hypertension Treatment Guidelines of JNC 8 recommend not using angiotensin receptor blockers (ARBs) and ACE inhibitors in the black population for first-line therapy. The Tolaki and Muna ethnicities are two indigenous ethnic groups of the Southeast Sulawesi Province of Indonesia. The very different physical characteristics between these two ethnic groups raise the possibility that there are differences in the body's response to antihypertensive ARBs, including candesartan. The study aimed to compare the efficacy and tolerability of candesartan cilexetil monotherapy for one month in hypertensive patients of the Tolaki and Muna ethnicities. Assessment of therapy efficacy includes the proportion of patients achieving the therapeutic target according to JNC 8 and the reduction of blood pressure. Tolerability is assessed based on side effects and adverse drug reactions (ADR) reported by patients. Patients who met the criteria for this study were those who had recently been diagnosed with essential hypertension or hypertension with type 2 diabetes mellitus, were taking candesartan cilexetil (8 mg orally once a day), and had blood pressure values after one month of treatment. Sixty-eight Tolaki ethnic patients and 51 Muna ethnic patients who met the inclusion criteria were included in this study. The results showed that the decrease in systolic and diastolic blood pressure was greater in the Tolaki than those in the Muna ethnicity. The median value of the systolic decrease was -33 ((-10)–(-60)) mmHg for the Tolaki ethnic group and -10 (0–(-20)) mmHg for the Muna ethnic group. The median value of diastolic decline for the Tolaki and Muna ethnicities was -10 (0–(-37)) mmHg and -5 (5–(-20)) mmHg, respectively. The MAP value of the Tolaki ethnic group is 93.30 (80–110), and that of the Muna ethnic group is 110 (96.69–130). The achievement of the target of reducing blood pressure was also significantly higher for the Tolaki than the Muna ethnicities. Complaints felt by some people in both ethnic groups were dizziness, headaches, and feeling weak. Six people in the Muna ethnic group with diabetes mellitus with type 2 experienced hyperkalemia. There was a significant difference in the efficacy of candesartan for one month between Muna and Tolaki ethnic hypertension patients. There was no difference in tolerability between the two ethnic groups.


Cite this article:
Mesi Leorita, Zullies Ikawati, Agung EndroNugroho, Ismail Setyopranoto. Comparison of the Efficacy and Tolerability of Candesartan Cilexetil between Hypertension patients of Muna and Tolaki Ethnicity. Research Journal of Pharmacy and Technology.2024; 17(4):1503-9. doi: 10.52711/0974-360X.2024.00238

Cite(Electronic):
Mesi Leorita, Zullies Ikawati, Agung EndroNugroho, Ismail Setyopranoto. Comparison of the Efficacy and Tolerability of Candesartan Cilexetil between Hypertension patients of Muna and Tolaki Ethnicity. Research Journal of Pharmacy and Technology.2024; 17(4):1503-9. doi: 10.52711/0974-360X.2024.00238   Available on: https://rjptonline.org/AbstractView.aspx?PID=2024-17-4-12


REFERENCES:
1.    Athiyah U, Rahem A, Setiawan CD. The Influence of Participation of the Social Security Agency (BPJS) Health on Therapeutic Success in Hypertension Patients at Community Health Centers. Research Journal of Pharmacy and Technology. 2019; 12: 93–98. https://doi.org/10.5958/0974-360X.2019.00018.0
2.    Maheshwari P, Shanmugarajan TS, Shanmugasundaram P. A Prospective Study on assessment of Quality of Prescribing in Patients with Hypertension using Prescription Quality Index (Pqi) Tool in a Tertiary Care Hospital. Research Journal of Pharmacy and Technology. 2019; 12: 541–544. https://doi.org/10.5958/0974-360X.2019.00095.7
3.    Kwon MJ, Ahn SY. Factors affecting Blood Pressure Control in Elderly Koreans with Hypertension. Research Journal of Pharmacy and Technology. 2018; 11: 1398–1403. https://doi.org/10.5958/0974-360X.2018.00261.5
4.    Minesh P, Chakraborthy GS. A Role of Clinical Trial in Management of Hypertension and Medication of Hypertension. Research Journal of Pharmacy and Technology. 2021; 14: 3215–3222. https://doi.org/10.52711/0974-360X.2021.00560
5.    Suganya VS, FirdousJT, K.apagam B, Varalakshmi A, Shanmughabriya S, Gomathi J, Sugunabai. Genotyping of Angiotensin Converting Enzyme (ACE 1) Gene in study subject with hypertension and Chronic Kidney Disease. Research Journal of Pharmacy and Technology. 2017; 10: 2607–2610. https://doi.org/10.5958/0974-360X.2017.00462.0
6.    Gallo G, Volpe M, Rubattu S. Angiotensin Receptor Blockers in the Management of Hypertension: A Real-World Perspective and Current Recommendations. Vasc. Health Risk Manag. 2022; 18: 507–515. https://doi.org/10.2147/VHRM.S337640
7.    Fryar CD, Zhang G, Ostchage Y, Hales MH, Moran DK. Hypertension Prevalence and Control Among Adults: United States 2015-2016, National Center for Health Service. 2017; 8. Available on: https://www.cdc.gov/nchs/data/databriefs/db220.pdf.
8.    Elsegaie D.  Formulation and In-vitro Characterization of Self Nano-emulsifying Drug Delivery System (SNEDDS) for enhanced Solubility of Candesartan Cilexetil. Research Journal of Pharmacy and Technology. 2019; 12: 2628–2636. https://doi.org/10.5958/0974-360X.2019.00440.2
9.    Sumathy P, Monika M. A Prospective Study on Comparative Efficacy between three Combinational Therapies for Hypertension. Research Journal of Pharmacy and Technology. 2017; 10: 273–276. https://doi.org/10.5958/0974-360X.2017.00056.7
10.    Flack JM, Buhnerkempe MG. Race and Antihypertensive Drug Therapy: Edging Closer to a New Paradigm. Hypertension. 2022; 79(2): 349–351.
11.    Belle DJ, Singh H. Genetic Factors In Drug Metabolism. Am. Fam. Physician. 2008; 77(11): 1553–1560.
12.    Sudjadi S, Sismindari S, Istighfari JR. Genom, Ekspresi dan Aplikasinya. Bursa Ilmu, Yogyakarta. 2019.
13.    Brewster LM, van Montfrans GA, Oehlers GP, Seedat YK. 2016. Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity. Intern. Emerg. Med. 2016; 11: 355–374. https://doi.org/10.1007/s11739-016-1422-x.
14.    Sinnott SJ, Douglas IJ, Smeeth L, Williamson E, Tomlinson LA.  First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care. BMJ. 2020; 371: m4080 1-10. https://doi.org/10.1136/bmj.m4080.
15.    James PA, Oparil S, Carter BL, Cushman, WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Jr Svetkey LP, Taler SJ, Townsend RR, Wright JT, Jr Narva AS, Ortiz E.2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311: 507–520. https://doi.org/10.1001/jama.2013.284427.
16.    NICE G. Hypertension in adults: diagnosis and management. NICE Guideline. 2019; 1-47. https://www.nice.org.uk/terms-andconditions#notice-of-rights
17.    Pitoyo AJ, Triwahyudi H. Dinamika Perkembangan Etnis di Indonesia dalam Konteks Persatuan Negara. Populasi. 2018; 25(1): 64–81. available on https://jurnal.ugm.ac.id/populasi/article/view/32416.
18.    Alimuddin MS.  Asal Usul Suku yang Mendiami Pulau Muna, Sulawesi Tenggara, Pustaka Ilmu, Kendari. 2015.
19.    Mekuo BL, Mardhan, Mekoa MD, Abbas S, Pamada M. Sistem Kepemimpinan Dalam Masyarakat Pedesaan Daerah Sulawesi Tenggara, Depdikbud RI, Jakarta.1986.
20.    Brown JD, Smith SM, Strotmeyer ES, Kritchevsky SB, Gill TM, Blair SN, Fielding RA, Buford TW, Pahor M, Manini TM. Comparative Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Response to a Physical Activity Intervention in Older Adults: Results From the Lifestyle Interventions and Independence for Elders Study. J. Gerontol. A. Biol. Sci. Med. Sci. 2020; 75: 1010–1016. https://doi.org/10.1093/gerona/glz120.
21.    Chen R, Suchard MA, Krumholz HM, Schuemie MJ, Shea S, Duke J, Pratt N, Reich CG, Madigan D, You SC, Ryan PB, Hripcsak G. Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study. Hypertension. 2021; 78(3): 591–603. https://doi.org/10.1161/HYPERTENSIONAHA.120.16667.
22.    Gallo G, Volpe M, Rubattu S. Angiotensin Receptor Blockers in the Management of Hypertension: A Real-World Perspective and Current Recommendations. Vasc. Health Risk Manag. 2022; 18: 507–515. https://doi.org/10.2147/VHRM.S337640
23.    Momoniat T, Ilyas D, Bhandari S. ACE inhibitors and ARBs: Managing potassium and renal function. Cleve. Clin. J. Med. 2019; 86(9): 601–607. https://doi.org/10.3949/ccjm.86a.18024.
24.    Raghuraman RP, Carney C, Mullahy H, Ogunseitan O, Wang D. Effects of Candesartan versus Amlodipine on Capillary Rarefaction, Pulse Wave Velocity and Central Blood Pressure in Patients with Essential Hypertension. HSOA Journal of Non Invasive Vascular Investigation. 2017; 2(8): 1-6. DOI 10.24966/NIVI-7400/100008.
25.    Farmalkes Kemenkes RI. Formularium Nasional 2017. Direktorat Jenderal Kefarmasian dan Alat Kesehatan. 2017. available on   URL https://farmalkes.kemkes.go.id/2018/02/formularium-nasional-2017/.
26.    Cernes R, Mashavi M, Zimlichman R. Differential clinical profile of candesartan compared to other angiotensin receptor blockers. Vasc. Health Risk Manag. 2011; 7: 749–759. https://doi.org/10.2147/VHRM.S22591.
27.    Buter H, Navis GY, Woittiez AJJ, de Zeeuw D, de Jong PE, Pharmacokinetics and pharmacodynamics of candesartan cilexetil in patients with normal to severely impaired renal function. Eur. J. Clin. Pharmacol. 1999; 54: 953–958. https://doi.org/10.1007/s002280050581.
28.    Ratnaparkhi MP.  Formulation and Evaluation of Sustained Release Floating Drug Delivery System of Candesartan Celexitil. Research Journal of Pharmacy and Technology. 2014; 7: 1253–1261.
29.    Samanthula KS, Satla SR, Bairi AG. Development, In-Vitro and Ex-Vivo Evaluation of Muco-adhesive Buccal patches of Candesartan cilexetil. Research Journal of Pharmacy and Technology, 2019; 12: 3038–3044. https://doi.org/10.5958/0974-360X.2019.00514.6
30.    Sunkara SP, Suryadevara V, Bathula S., Doppalapudi S, Padarthi PK, KunamV. 2020. Formulation and Evaluation of Candesartan Cilexetil Fast Dissolving Tablets using Inclusion Complexes. Research Journal of Pharmacy and Technology. 2020; 13: 751–757. https://doi.org/10.5958/0974-360X.2020.00142.0
31.    Bantas K, Gayatri D. Gender and Hypertension (Data analysis of The Indonesia Basic Health Research 2007). J. Epidemiologi Kesehatan Indonesia. 2019;3(1): 7-17. https://doi.org/10.7454/epidkes.v3i1.3142
32.    Fryar CD, Zhang G, Ostchage Y, Hales MH, Moran DK. Hypertension Prevalence and Control Among Adults: United States 2015-2016, National Center for Health Service. 2017; 8. Available on: https://www.cdc.gov/nchs/data/databriefs/db220.pdf.
33.    Setiawati A, Pohan T. Safety and effectiveness of candesartan and candesartan/HCT fixed dose combination in patients with hypertension. Acta Medica Indonesia. 2013; 45(3): 193–201.
34.    Basu R.  Risk Factors for Type 2 Diabetes National Institute of Diabetes and Digestive and Kidney Diseases. 2022. https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes.
35.    Ohishi M. Hypertension with diabetes mellitus: physiology and pathology. Hypertens. 2018; Res 41:389–393. https://doi.org/10.1038/s41440-018-0034-4
36.    Sesso HD, Stampfer MJ, Rosner B. Hennekens CH, Gaziano JM, Manson JE, Glynn RJ. Systolic and Diastolic Blood Pressure, Pulse Pressure, and Mean Arterial Pressure as Predictors of Cardiovascular Disease Risk in Men. Hypertension. 2000; 36: 801–807. https://doi.org/10.1161/01.HYP.36.5.801
37.    Janghorbani M, Amini M. Comparison of systolic and diastolic blood pressure with pulse pressure and mean arterial pressure for prediction of type 2 diabetes: The Isfahan Diabetes Prevention Study. Endokrynol. Pol. 2011; 62(4): 324-320.
38.    Melgarejo J, Yi Yang W, Lutgarde T, Yan Li YL, Asayama K, Hansen. Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure. Hypertension.  2021; 77: 39–48. DOI: 10.1161/HYPERTENSIONAHA.120.14929.
39.    Gu A, Yue Y, Desai RP, Argulian . Racial and Ethnic Differences in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension. Circulation: Cardiovascular Quality and Outcomes. AHA Journal. 2017; 10(1): e003166. https://doi.org/10.1161/CIRCOUTCOMES.116.003166
40.    Ogihara T, Arakawa K. Clinical efficacy and tolerability of candesartan cilexetil. Candesartan Study Groups in Japan. J Hum Hypertens.1999; 13Suppl (1): S27-31; discussion S33-4. https://doi.org/10.1038/sj.jhh.1000746
41.    Rakugi H, Tashio O, Yuko Miyata, Sasai K, Totsuka N. Evaluation of the Efficacy and Tolerability of Combination Therapy With Candesartan Cilexetil and Amlodipine Besilate Compared With Candesartan Cilexetil Monotherapy and Amlodipine Besilate Monotherapy in Japanese Patients With Mild-to-Moderate Essential Hypertension: A Multicenter, 12-Week, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study – ClinicalKey. Clinical Therapeutics. 2012; 34(4): 838-848available on  https://www-clinicalkey-com.ezproxy.ugm.ac.id/#!/content/journal/1-s2.0-S014929181200094X
42.    Association of Black Cardiologists (ABC) Candesartan Study Group. Evaluation of candesartan cilexetil in black patients with systemic hypertension: the ABC Trial. Heart Dis. Hagerstown Md. 2000; 2(6): 392–399.
43.    Chang R, Yingying S, Julia L, Taher YHL. Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System. Hypertension. 2016; 67: 1181-1188. https://doi.org/10.1161/HYPERTENSIONAHA.116.07363.
44.    Simon LV, Hashmi MF, Farrell MW.  Hyperkalemia, in: StatPearls. 2022 StatPearls Publishing, Treasure Island (FL).
45.    Belle DJ, Singh H. Genetic influences on drug metabolism interact with other intrinsic (i.e., physiologic) and extrinsic (i.e., cultural, behavioral, and environmental) characteristics of a person to determine treatment outcome with any pharmacologic agent. Physicians need to be aware of these genetic variations, especially as genomic-based treatment guidelines become available. 2008;77(11): 1553-1560.
46.    Gupta AK. Racial Differences in Response to Antihypertensive Therapy: Does One Size Fits All? Int J Prev Med. 2010; 1: 217–219.

Recomonded Articles:

Research Journal of Pharmacy and Technology (RJPT) is an international, peer-reviewed, multidisciplinary journal.... Read more >>>

RNI: CHHENG00387/33/1/2008-TC                     
DOI: 10.5958/0974-360X 

1.3
2021CiteScore
 
56th percentile
Powered by  Scopus


SCImago Journal & Country Rank


Recent Articles




Tags


Not Available