title: Azelnidipine plus olmesartan versus amlodipine plus olmesartan on arterial stiffness and cardiac function in hypertensive patients: a randomized trial.
abstract: OBJECTIVE
  To compare the long-term effects of olmesartan combined with either azelnidipine or amlodipine on central blood pressure (CBP), left ventricular (LV) mass index (LVMI), LV diastolic function (e' velocity, E/e' ratio, E/A ratio) and arterial stiffness (brachial-ankle pulse wave velocity [baPWV] and augmentation index normalized for a heart rate of 75 bpm [AIx]).
  
  
  METHODS
  Patients with systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg received olmesartan monotherapy (20 mg/day) for 12 weeks. They were then randomly assigned to fixed-dose add-on therapy with azelnidipine (16 mg/day; n = 26) or amlodipine (5 mg/day; n = 26) for a further 2 years. CBP, LVMI, e' velocity, E/e' ratio, E/A ratio, baPWV, and AIx were measured at baseline, 6 months, and 2 years.
  
  
  RESULTS
  Baseline characteristics of both groups were similar. The decrease in brachial BP over 2 years was similar in both groups. CBP, LVMI, E/e' ratio, baPWV, and AIx decreased significantly, and the E/A ratio and e' velocity increased significantly in both groups. The decreases in CBP (P < 0.001), AIx (P < 0.001), baPWV (P < 0.001), LVMI (P < 0.001), and E/e' (P = 0.002) as well as the increase in E/A ratio (P = 0.03) over 2 years were significantly greater in the olmesartan/azelnidipine group than in the olmesartan/amlodipine group. Multivariate linear regression analyses showed that the changes in baPWV (β = 0.41, P < 0.001) and CBP (β = 0.47, P = 0.01) were independently associated with the change in LVMI, the change in baPWV (β = 0.25, P < 0.001) was independently associated with the change in E/e' ratio, and the changes in baPWV (β = 0.21, P = 0.001) and AIx (β = 0.25, P = 0.03) were independently associated with the change in E/A ratio.
  
  
  CONCLUSIONS
  Treatment with olmesartan/azelnidipine for 2 years resulted in greater improvements in CBP, LVMI, and LV diastolic function, and arterial stiffness compared with olmesartan/amlodipine. Improvements in LV diastolic function were associated with improvements in arterial stiffness.
authors: Department of Internal Medicine, Clinic Jingumae, Kashihara, Nara, Japan. takami66@m5.kcn.ne.jp
authors: Takeshi
authors: T
authors: Takami
authors: Yoshihiko
authors: Y
authors: Saito
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage*; D001383:Azetidinecarboxylic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003971:Diastole / Q000187:drug effects; D004095:Dihydropyridines / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy; D007093:Imidazoles / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D013777:Tetrazoles / Q000008:administration & dosage*; D059289:Vascular Stiffness / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D004095:Dihydropyridines; D007093:Imidazoles; D013777:Tetrazoles; D017311:Amlodipine; D001383:Azetidinecarboxylic Acid; C437965:olmesartan; C061679:azelnidipine
keywords: arterial stiffness; central blood pressure; left ventricular diastolic function; left ventricular mass index; olmesartan/azelnidipine
references: Ann Intern Med. 1992 Sep 15;117(6):502-10
references: 1503353
references: Circulation. 2006 Mar 7;113(9):1213-25
references: 16476843
references: J Cardiovasc Transl Res. 2012 Jun;5(3):280-6
references: 22223090
references: Am J Hypertens. 2002 Jan;15(1 Pt 1):24-30
references: 11824855
references: J Hypertens. 2009 Sep;27(9):1784-8
references: 19702000
references: Eur Heart J. 2013 Sep;34(36):2839-49
references: 22833515
references: Kardiol Pol. 2012;70(3):223-31
references: 22430399
references: J Am Coll Cardiol. 2002 Jun 19;39(12):2005-11
references: 12084601
references: J Hypertens. 2013 Mar;31(3):508-15; discussion 515
references: 23235360
references: J Hypertens. 2000 Nov;18(11):1527-35
references: 11081763
references: Am J Cardiol. 2010 Oct 1;106(7):999-1005
references: 20854964
references: J Am Coll Cardiol. 2004 Feb 4;43(3):360-7
references: 15013115
references: J Hum Hypertens. 2011 Mar;25(3):152-8
references: 20428193
references: Hypertension. 2007 Jul;50(1):197-203
references: 17485598
references: Hypertension. 2009 Oct;54(4):716-23
references: 19667251
references: Am J Hypertens. 2001 Feb;14(2):91-7
references: 11243313
references: Hypertens Res. 2004 Sep;27(9):625-31
references: 15750255
references: J Cardiovasc Pharmacol. 2009 Apr;53(4):325-32
references: 19295444
references: CNS Drugs. 2005;19(1):1-11
references: 15651901
references: Heart. 2005 Dec;91(12):1551-6
references: 16287739
references: Hypertens Res. 2007 Mar;30(3):219-28
references: 17510503
references: J Cardiovasc Pharmacol. 1989;13 Suppl 1:S18-24
references: 2468972
references: Hypertens Res. 2009 Jan;32(1):3-107
references: 19300436
references: Nat Clin Pract Cardiovasc Med. 2005 Sep;2(9):450-5
references: 16265585
references: Circulation. 2001 Sep 11;104(11):1248-54
references: 11551875
references: Clin Exp Hypertens. 2012;34(6):410-6
references: 22471755
references: Circulation. 2000 Oct 10;102(15):1788-94
references: 11023933
references: J Hypertens. 2006 Oct;24(10):2057-69
references: 16957567
references: Vasc Health Risk Manag. 2011;7:383-90
references: 21796252
references: Hypertens Res. 2009 Oct;32(10):895-900
references: 19680260
references: J Card Fail. 2002 Dec;8(6 Suppl):S465-71
references: 12555159