At 24 weeks the adjusted mean reductions in sitting diastolic blood pressures were 10.4 mmHg on Atacand (p<0.001) and 10.7 mmHg on Zestril (p<0.001). Sitting systolic blood pressure also fell significantly on both treatments, the reduction on Atacand being 14.1 mmHg (p<0.001) and on Zestril 16.7 mmHg (p<0.001).
Standing diastolic and systolic blood pressures were also markedly reduced and to a similar extent by the two drugs. Atacand and Zestril both reduced urinary albumin/creatinine ratio. At 24 weeks there was a 24% reduction in the group of patients treated with Atacand and a 39% reduction in the Zestril group. The difference between the drugs was not significant.
One third of the patients in the study were treated from weeks 12 to 24 with Atacand 16 mg once daily and Zestril 20 mg once daily given together. This regimen resulted in a greater fall in blood pressure than monotherapy with either drug with a mean reduction of 16.3 mmHg in sitting diastolic pressure (p<0.001) and 25.3 mmHg (p<0.001) in systolic pressure. Combined treatment also significantly reduced albumin/creatinine ratio.
All treatment regimens in the CALM study were generally well tolerated. The most common adverse events during any of the treatment regimens were respiratory infection, cough and headache which occurred in less than 10% of patients. Only 14 of 197 randomised patients stopped treatment due to adverse effects during the 24-week period. No marked changes in mean values for HbA1c or any routine laboratory variables were observed.