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Pathway Description
Candesartan Action Pathway
Homo sapiens
Drug Action Pathway
Candesartan (also named Blopress or Atacand) is an active metabolite of angiotensin II receptor blockers (ARBs) pro drug, candesartan cilexetil. Candesartan cilexetil converts to candesartan rapidly in gastrointestinal tract during absorption. Candesartan competes with angiotensin II to bind type-1 angiotensin II receptor (AT1) in many tissues (e.g. vascular smooth muscle, the adrenal glands, etc.) to prevent increasing sodium, water reabsorption and peripheral resistance (that will lead to increasing blood pressure) via aldosterone secretion that is caused by angiotensin II. Therefore, action of candesartan binding to AT1 will result in decreasing blood pressure. For more information on the effects of aldosterone on electrolyte and water excretion, refer to the description of the spironolactone or triamterene pathways, which describes the mechanism of direct aldosterone antagonists. Candesartan is an effective agent for reducing blood pressure and may be used to treat essential hypertension and heart failure.
References
Candesartan Pathway References
Bader, M. Renin-angiotensin-aldosterone system. In S. Offermanns, & W. Rosenthal (Eds.). Encyclopedic reference of molecular pharmacology (2004) p.810-814. Berlin, Germany: Springer.
[http://www.drugbank.ca](http://www.drugbank.ca/drugs/DB00796)
Stanfield, C.L., & Germann, W.J. Principles of human physiology (3rd ed.) (2008). San Francisco, CA: Pearson Education, Inc.;
Lee SR, Chae IH, Kim HL, Kang DY, Kim SH, Kim HS: Predictors of candesartan's effect on vascular reactivity in patients with coronary artery disease. Cardiovasc Ther. 2017 Oct;35(5). doi: 10.1111/1755-5922.12291.
Pubmed: 28796934
Koh KK, Han SH, Chung WJ, Ahn JY, Jin DK, Kim HS, Park GS, Kang WC, Ahn TH, Shin EK: Comparison of effects of losartan, irbesartan, and candesartan on flow-mediated brachial artery dilation and on inflammatory and thrombolytic markers in patients with systemic hypertension. Am J Cardiol. 2004 Jun 1;93(11):1432-5, A10. doi: 10.1016/j.amjcard.2004.02.050.
Pubmed: 15165934
Perrone-Filardi P, Corrado L, Brevetti G, Silvestro A, Dellegrottaglie S, Cafiero M, Caiazzo G, Petretta A, Maglione A, Monda C, Guerra G, Marzano A, Cesarano P, Gargiulo P, Chiariello M: Effects of AT1 receptor antagonism with candesartan on endothelial function in patients with hypertension and coronary artery disease. J Clin Hypertens (Greenwich). 2009 May;11(5):260-5.
Pubmed: 19534023
Agata J, Nagahara D, Kinoshita S, Takagawa Y, Moniwa N, Yoshida D, Ura N, Shimamoto K: Angiotensin II receptor blocker prevents increased arterial stiffness in patients with essential hypertension. Circ J. 2004 Dec;68(12):1194-8. doi: 10.1253/circj.68.1194.
Pubmed: 15564706
Sasamura H, Kitamura Y, Nakamura M, Ryuzaki M, Saruta T: Effects of the angiotensin receptor blocker candesartan on arterial stiffness and markers of extracellular matrix metabolism in patients with essential hypertension. Clin Exp Hypertens. 2006 Jul;28(5):511-20. doi: 10.1080/10641960600798721.
Pubmed: 16820347
Uehara G, Takeda H: Relative effects of telmisartan, candesartan and losartan on alleviating arterial stiffness in patients with hypertension complicated by diabetes mellitus: an evaluation using the cardio-ankle vascular index (CAVI). J Int Med Res. 2008 Sep-Oct;36(5):1094-102. doi: 10.1177/147323000803600529.
Pubmed: 18831906
Angiotensin Metabolism References
Hussain M, Awan FR: Hypertension regulating angiotensin peptides in the pathobiology of cardiovascular disease. Clin Exp Hypertens. 2018;40(4):344-352. doi: 10.1080/10641963.2017.1377218. Epub 2017 Nov 30.
Pubmed: 29190205
Mori J, Zhang L, Oudit GY, Lopaschuk GD: Impact of the renin-angiotensin system on cardiac energy metabolism in heart failure. J Mol Cell Cardiol. 2013 Oct;63:98-106. doi: 10.1016/j.yjmcc.2013.07.010. Epub 2013 Jul 22.
Pubmed: 23886814
Yim HE, Yoo KH: Renin-Angiotensin system - considerations for hypertension and kidney. Electrolyte Blood Press. 2008 Jun;6(1):42-50. doi: 10.5049/EBP.2008.6.1.42. Epub 2008 Jun 30.
Pubmed: 24459521
Manrique C, Lastra G, Gardner M, Sowers JR: The renin angiotensin aldosterone system in hypertension: roles of insulin resistance and oxidative stress. Med Clin North Am. 2009 May;93(3):569-82. doi: 10.1016/j.mcna.2009.02.014.
Pubmed: 19427492
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