title: Enhanced blood pressure-lowering effect of olmesartan in hypertensive patients with chronic kidney disease-associated sympathetic hyperactivity: HONEST study.
abstract: To investigate the blood pressure (BP)-lowering effect of olmesartan in relation to chronic kidney disease (CKD)-associated sympathetic nerve activity, a subanalysis was performed using data from the first 16 weeks of the Home BP Measurement With Olmesartan-Naive Patients to Establish Standard Target Blood Pressure (HONEST) study, a prospective observational study of hypertensive patients. Essential hypertensive patients who took no antihypertensive agent at baseline were classified based on baseline morning home systolic BP (MHSBP) in quartiles. In each class, patients were further classified based on baseline morning home pulse rate (MHPR). A subgroup analysis in patients with/without chronic kidney disease (CKD) was performed. A total of 5458 patients (mean age, 63.0 years; 51.6% women) were included. In the 4th quartile of baseline MHSBP (≥165 mm Hg), patients with MHPR ≥70 beats per minute had a greater BP reduction (by 3.2 mm Hg) than those with MHPR <70 beats per minute after 16 weeks of olmesartan-based treatment (P=.0005). An even greater BP reduction (by 6.6 mm Hg) was observed in patients with CKD than in patients without CKD in this group (P=.0084). Olmesartan was more effective in hypertensive patients with high MHSBP and MHPR ≥70 beats per minute, especially in patients with CKD. Olmesartan may have enhanced BP-lowering effects by improving renal ischemia in hypertensive CKD patients with potential increased sympathetic nerve activity.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan. kkario@jichi.ac.jp
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Ikuo
authors.initials: I
authors.lastname: Saito
authors.forename: Toshio
authors.initials: T
authors.lastname: Kushiro
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mori
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Hiramatsu
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kobayashi
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology*; D013777:Tetrazoles / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan
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