The Candesartan medication and Lisinopril Micro-albuminuria (CALM) study was one of the first to show that combining two drugs—an angiotensin-coverting enzyme (ACE)-inhibitor and an angio-tensin II receptor blocker—might be more effective than one drug in keeping blood pressure (BP) down in patients with diabetes. The CALM II study aimed to compare the long-term safety and efficacy of dual blockade with a single drug.
Patients received either lisinopril (e.g., Generic Zestril, AstraZeneca) 40 mg daily or candesartan cilexitil (Atacand drug, Astra-Zeneca) 16 mg daily and canadian lisinopril 20 mg daily. Fifteen of the 75 patients also needed a thiazide diuretic because of insufficient BP reduction.
Both treatments reduced systolic BP and stabilized the urinary albumin-to-creatinine ratio. Dual blockade was more effective for daytime BP and 24-hour and night systolic BP, but the trend was not significant.