Effective systolic blood pressure reduction with olmesartan medoxomil/amlodipine combination therapy: post hoc analysis of data from a randomized, double-blind, parallel-group, multicentre study.

摘要

BACKGROUND AND OBJECTIVE: Systolic blood pressure (SBP) strongly predicts cardiovascular risk and is an important factor to evaluate in studies of antihypertensive treatments. A recent randomized controlled study has shown that the angiotensin II type 1 receptor antagonist (angiotensin receptor blocker [ARB]) olmesartan medoxomil (hereafter olmesartan) combined with the calcium channel antagonist (calcium channel blocker) amlodipine can control SBP in a majority of patients with moderate-to-severe hypertension. The aim of this report is to present results from a post hoc analysis of this study to further evaluate the effects of this combination on SBP. METHODS: A post hoc analysis of changes in seated SBP (SeSBP) levels in patients treated with olmesartan 40 mg plus amlodipine 5 or 10 mg was carried out to investigate the distribution of SeSBP changes produced by this combination. Patients who reached the end of the 52-week study were categorized by size of SeSBP reduction from baseline as follows: 15 to 30 to 45 mmHg. RESULTS: In 578 patients who received olmesartan/amlodipine 40 mg/5 mg or 40 mg/10 mg and completed the study, the mean SeSBP reduction from baseline was 31.18 mmHg, and the proportions of patients with SeSBP reductions 15 to 30 to 45 mmHg were 12.8%, 36.0%, 35.3% and 15.9%, respectively. In patients who received olmesartan/amlodipine 40 mg/10 mg, the proportion of patients in the 45 mmHg group was larger (21.6%). Moreover, patients in the >45 mmHg category showed the greatest reduction in SeSBP from baseline (53.5 mmHg for olmesartan/amlodipine 40 mg/10 mg recipients). Categorical analysis of patients treated with olmesartan/amlodipine 40 mg/10 mg in a separate, factorial study showed similar results: SeSBP reductions of 15 to 30 to 45 mmHg were seen in 17%, 34%, 36% and 14% of patients, respectively. CONCLUSION: Treatment with a combination based upon olmesartan 40 mg plus amlodipine 5 or 10 mg effectively reduces elevated SeSBP, particularly in patients with high levels of SeSBP.