Comparison of combination therapies, including the angiotensin receptor blocker olmesartan and either a calcium channel blocker or a thiazide diuretic, in elderly patients with hypertension.
The blood pressure goals set for the treatment of hypertensive patients have been lowered in recent guidelines. To reduce blood pressure levels sufficiently, combination therapies are often needed, but there is little evidence about which combination should be chosen. The present study was carried out to compare the effects of combination therapies, including the angiotensin receptor blocker olmesartan and either a calcium channel blocker (CCB) or a thiazide diuretic, in elderly patients with hypertension. A total of 65 patients aged 65-85 years, with blood pressures of 140/90 mmHg or higher for those taking antihypertensive medication or 160/100 mmHg or higher for those not on medication, were randomly assigned to either the group treated with olmesartan plus a dihydropyridine CCB or the group treated with olmesartan plus a thiazide diuretic; 58 patients completed the treatment for 6 months. Systolic and diastolic blood pressures (SBP and DBP) were reduced during the treatment period in both the groups. The reductions in SBP at 1 and 6 months were significantly (P<0.05) greater in the CCB combination group than in the diuretic group (-29 vs. -18 mmHg, respectively, at 1 month; -32 vs. -23 mmHg, respectively, at 6 months). Despite greater reduction in SBP in the CCB group, the serum creatinine level and the estimated glomerular filtration rate (eGFR) remained unchanged, whereas in the diuretic group, creatinine was elevated (+0.06 mg per 100 ml, P<0.05) and eGFR was reduced (-4.5 mlmin(-1) per 1.73 m(2)). In addition, high-density lipoprotein cholesterol levels were reduced in the diuretic group (-5.0 mg per 100 ml, P<0.01). These results suggest that olmesartan plus a CCB is the preferable combination therapy in comparison with olmesartan plus a thiazide diuretic for elderly patients with hypertension.
Frontier Science Research Center, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan. jkjpn@med.miyazaki-u.ac.jp
Johji
J
Kato
Naoto
N
Yokota
Noboru
N
Tamaki
Sumito
S
Kariya
Toshihiro
T
Kita
Takao
T
Ayabe
Tanenao
T
Eto
Kazuo
K
Kitamura
D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D008076:Cholesterol, HDL / Q000097:blood / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D004095:Dihydropyridines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D008076:Cholesterol, HDL; D004095:Dihydropyridines; D007093:Imidazoles; D049993:Sodium Chloride Symporter Inhibitors; D013777:Tetrazoles; C437965:olmesartan; D003404:Creatinine