Candesartan: A Comprehensive Pharmacological and Clinical Monograph

Section 1: Introduction and Physicochemical Profile

Candesartan is a potent, long-acting, and highly selective angiotensin II receptor blocker (ARB) that has become a cornerstone in the management of cardiovascular diseases, primarily hypertension and heart failure. As a member of the ARB class, its therapeutic efficacy is rooted in its ability to antagonize the physiological effects of angiotensin II, the principal pressor agent of the renin-angiotensin-aldosterone system (RAAS). Unlike its predecessors and some contemporaries in the class, candesartan possesses a unique pharmacological profile characterized by insurmountable antagonism and exceptionally high affinity for its target receptor, which translates into robust and sustained clinical effects. This monograph provides a comprehensive review of candesartan, encompassing its fundamental chemistry, detailed pharmacology, pharmacokinetics, pivotal clinical trial evidence, comparative efficacy, and safety profile.

1.1. Chemical Identity and Structure

Candesartan (DrugBank ID: DB13919) is a small molecule, nonpeptide drug belonging to the benzimidazolecarboxylic acid and biphenylyltetrazole chemical classes.[1] Its formal chemical name is 2-ethoxy-1-((2'-(1H-tetrazol-5-yl)[1,1'-biphenyl]-4-yl)methyl)-1H-benzimidazole-7-carboxylic acid.[1] The molecular formula of the active drug is

C24​H20​N6​O3​, corresponding to a molecular weight of approximately 440.45 g/mol.[2] It is uniquely identified by the Chemical Abstracts Service (CAS) Number 139481-59-7.[2] Common synonyms used in research and development include CV-11974, Candesartan M1, and Celexetil.[1]