title: Comparative Study of the Efficacy of Olmesartan/Amlodipine vs. Perindopril/Amlodipine in Peripheral and Central Blood Pressure Parameters After Missed Dose in Type 2 Diabetes.
abstract: Central aortic blood pressure (CBP) and CBP-derived parameters are independent predictors of cardiovascular risk. Angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors plus calcium channel blockers are the recommended first-line treatments in hypertensive diabetic patients; however, the effect in reducing CBP when a dose is skipped has not been established yet. The aim was to determine whether the fixed-dose combination of olmesartan/amlodipine (OLM/AML) provides equal efficacy and safety as the perindopril/AML (PER/AML) combination in reducing CBP, augmentation index (AIx), and pulse wave velocity (PWV) when a drug dose is missed.
  
  
  
  In this noninferiority, randomized, double-blind, double-dummy parallel group, controlled design trial, 88 patients received either OLM 20-40mg/AML 5-10mg (41 patients) or PER 4-8mg/AML 5-10mg (47 patients) for 24 weeks. The main endpoint was the aortic systolic BP (SBP) after 24 weeks of treatment at 48 hours from the last administration.
  
  
  
  The OLM/AML combination reached the noninferiority criteria in reducing central systolic BP after 24 weeks of treatment and after the missed dose, compared to the PER/AML combination (-17 and -8mm Hg, respectively). Peripheral BP, AIx, and PWV were significantly lower in both groups after 24 weeks of treatment and 48 hours after the missed dose, observing a trend to a greater reduction in CBP-derived parameters in the OLM/AML group.
  
  
  
  The OLM/AML combination is safe, well tolerated, and not inferior to the combination of PER/AML in lowering CBP and CBP-derived parameters in diabetic patients. OLM/AML provides longer-lasting efficacy in terms of CBP reduction compared to PER/AML.
authors.affiliation: Hypertension Clinic, Department of Internal Medicine, Clinical Hospital of Valencia, INCLIVA, University of Valencia, Valencia, Spain; CIBERObn, Instituto de Salud Carlos III, Madrid, Spain. josep.redon@uv.es.
authors.forename: Josep
authors.initials: J
authors.lastname: Redon
authors.affiliation: Hypertension Clinic, Department of Internal Medicine, Clinical Hospital of Valencia, INCLIVA, University of Valencia, Valencia, Spain;
authors.forename: Gernot
authors.initials: G
authors.lastname: Pichler
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007093:Imidazoles / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000008:administration & dosage; D063177:Pulse Wave Analysis; D013777:Tetrazoles / Q000008:administration & dosage
chemical_list: D000959:Antihypertensive Agents; D007093:Imidazoles; D013777:Tetrazoles; D017311:Amlodipine; C437965:olmesartan; D020913:Perindopril
keywords: cardiovascular risk; central blood pressure; diabetes; fixed-dose combination; hypertension; missed dose.