Relative efficacy of an angiotensin II antagonist compared with other antihypertensive agents. Olmesartan medoxomil versus antihypertensives.
OBJECTIVE
To compare the relative efficacy and safety of olmesartan medoxomil (OM) with atenolol, captopril and losartan in phase III trials on mild to severely hypertensive patients.


METHODS
Multi-centre, randomized, double-blind, parallel group, with dose-titration studies lasting 12 or 24 weeks.


METHODS
Two studies respectively compared 10 mg OM once daily (o.d.) with: (1) 50 mg atenolol o.d. in moderate to severe hypertensives receiving 25 mg hydrochlorothiazide o.d. over 12 weeks; and (2) 50 mg losartan o.d. in mild to moderate hypertensives over 24 weeks, both with dose doubling at week4 if required. Study 3 compared 5 mg OM o.d. plus placebo o.d.with 12.5 mg captopril twice daily in mild to moderate hypertensives over 12 weeks, with dose doubling at weeks 4 and 8 if required. The primary outcome measure for all studies was the change from baseline to week 12 in trough mean sitting diastolic blood pressure (DBP). Safety was monitored throughout all studies.


RESULTS
(1) Atenolol and OM both reduced BP effectively in moderate to severe hypertensives. OM was significantly superior to: (2) losartan (95% confidence interval for baseline to week 12 change in DBP < 0, lower limit < -3.6 mmHg); and (3) captopril (95% confidence interval for baseline to week 12 change in DBP < 0, lower limit < -4.8 mmHg) in BP reduction for mild to moderate hypertensives. Treatment with OM was safe and well tolerated.


CONCLUSIONS
At the doses tested, olmesartan medoxomil o.d. is as effective as atenolol, and more effective than both losartan and captopril in reducing blood pressure in the hypertensive population.
Ball
K J
KJ
The Old School Surgery, Leicestershire, UK.
Williams
P A
PA
Stumpe
K O
KO
D000804:Angiotensin II / Q000037:antagonists & inhibitors*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001262:Atenolol / Q000009:adverse effects / Q000627:therapeutic use; D002216:Captopril / Q000009:adverse effects / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007093:Imidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D000068557:Olmesartan Medoxomil; D016032:Randomized Controlled Trials as Topic; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D007093:Imidazoles; D013777:Tetrazoles; D000804:Angiotensin II; D001262:Atenolol; D000068557:Olmesartan Medoxomil; D002216:Captopril; D019808:Losartan