Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study.
We studied the effects of treatment with olmesartan/amlodipine and olmesartan/hydrochlorothiazide on inflammatory and metabolic parameters (including new-onset diabetes as a secondary endpoint) in non-diabetic hypertensive patients with metabolic syndrome (MetS). A total of 120 patients with MetS and stage I and II hypertension were randomized to olmesartan 20 mg/amlodipine 5 mg or olmesartan 20 mg/hydrochlorothiazide 12.5 mg. If target systolic blood pressure (<140 mm Hg) was not reached, doses were doubled after 13 weeks; doxazosin 4 mg was added after 26 weeks, and doubled after 39 weeks; follow-up ended at 78 weeks. At each visit, blood pressure (BP), fasting plasma glucose, insulin, adiponectin, tumour necrosis factor-α, C-reactive protein (CRP), intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukins-1β, -6 and -8, and albuminuria were measured; BP was similarly reduced in both groups; 80% of patients reached target BP. Reductions in albuminuria were also similar (50%). Only olmesartan/amlodipine reduced the insulin resistance index (24%, P<0.01), increased plasma adiponectin (16%, P<0.05) and significantly reduced all of the inflammation markers studied, except CRP, which showed a similar reduction in each group. The risk of new-onset diabetes was significantly lower with olmesartan/amlodipine (P=0.02). Both olmesartan-based combinations were effective, but the amlodipine combination resulted in metabolic and anti-inflammatory effects that may have advantages over the hydrochlorothiazide combination.
Outpatient Hypertension Clinic, Hospital Universitario Dr. Negrin, Barranco de la Ballena, Las Palmas de Gran Canaria, Spain. dr.j.martinez@gmail.com
F J
FJ
Martinez-Martin
H
H
Rodriguez-Rosas
I
I
Peiro-Martinez
P
P
Soriano-Perera
P
P
Pedrianes-Martin
C
C
Comi-Diaz
D052242:Adiponectin / Q000097:blood; D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000494:pharmacology / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002097:C-Reactive Protein / Q000378:metabolism; D015897:Comorbidity; D016207:Cytokines / Q000097:blood; D003924:Diabetes Mellitus, Type 2; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000494:pharmacology / Q000627:therapeutic use*; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D015994:Incidence; D007333:Insulin Resistance / Q000502:physiology; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D052242:Adiponectin; D000959:Antihypertensive Agents; D016207:Cytokines; D007093:Imidazoles; D013777:Tetrazoles; D019010:Vascular Cell Adhesion Molecule-1; D006852:Hydrochlorothiazide; D018799:Intercellular Adhesion Molecule-1; D017311:Amlodipine; C437965:olmesartan; D002097:C-Reactive Protein