title: Effectiveness of olmesartan-based treatment on home and clinic blood pressure in elderly patients with masked and white coat hypertension.
abstract: Few large-scale studies have evaluated the effectiveness of angiotensin receptor blockers in patients with masked hypertension (MH) and white coat hypertension (WCH) based on age using real-world blood pressure (BP) data. We used data from the Home BP measurement with Olmesartan Naive patients to Establish Standard Target BP (HONEST) study to investigate the effectiveness of olmesartan-based treatment by patient age (<65 years of age, n = 9817; 65-74 years of age, n = 6792; ⩾ 75 years of age, n = 4732), focusing on morning home BP (strongly associated with cardiovascular disease and useful for MH and WCH diagnosis). Sixteen weeks of treatment changed morning home BP (mean systolic/diastolic) by -18.1/-9.7, -15.9/-7.4 and -14.2/-6.4 mm Hg and clinic BP by -20.1/-11.3, -17.3/-8.7 and -15.4/-7.2 mm Hg, in these age groups, respectively (P < 0.0001). Pulse pressure decreased (-7.8 to -8.8 mm Hg, P < 0.0001). Patients aged ⩾ 80 years experienced similar BP and pulse pressure changes. In patients aged ⩾ 75 years, mean morning and clinic BP after 16 weeks was 137.5/74.8 and 129.7/70.4 mm Hg, respectively, in MH patients and 132.3/72.2 and 139.7/72.7 mm Hg, respectively, in WCH patients. Regardless of age, only elevated clinic or home BP values decreased to target ranges. The incidence of adverse effects associated with excessive BP lowering was low in all of the age groups. In conclusion, our study suggests that olmesartan-based treatment was safe and useful for managing MH, WCH and sustained hypertension in elderly patients. The lack of a placebo group was a limitation of the study.
authors.affiliation: The Life Planning Center Foundation, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kushiro
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.affiliation: Keio University, Kanagawa, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Saito
authors.affiliation: Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.affiliation: Daiichi Sankyo, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Daiichi Sankyo, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Okuda
authors.affiliation: Shin-Oyama City Hospital, Tochigi, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology* / Q000627:therapeutic use*; D008297:Male; D059468:Masked Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D009819:Office Visits; D011446:Prospective Studies; D013599:Systole / Q000187:drug effects / Q000502:physiology; D013777:Tetrazoles / Q000494:pharmacology* / Q000627:therapeutic use*; D016896:Treatment Outcome; D059466:White Coat Hypertension / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan