A Review of the Efficacy of Fixed-Dose Combinations Olmesartan Medoxomil/Hydrochlorothiazide and Amlodipine Besylate/Benazepril in Factorial Design Studies

Abstract

In order to adequately control hypertension, the majority of patients will require treatment with more than one antihypertensive agent. Fixed-dose combination therapy offers several advantages, including improved efficacy, tolerability, and treatment compliance. Certain combinations have benefits in specific patient populations, such as the elderly or those with comorbidities. In this review, we evaluate the BP-lowering efficacy of olmesartan medoxomil/hydrochlorothiazide (HCTZ) and amlodipine besylate/benazepril in similarly designed, randomized, placebo-controlled studies in similar patient populations. This indirect comparison showed that both combinations significantly improve both systolic and diastolic BP compared with monotherapy with the individual agents or placebo; it also demonstrated that the combinations were well tolerated. Both combination therapies significantly improved response rates, but olmesartan medoxomil/HCTZ achieved the highest control rates compared with the individual agents. On the basis of an indirect comparison of published factorial design studies, olmesartan medoxomil/HCTZ appears to be at least as effective as amlodipine besylate/benazepril and may provide quantitatively greater reductions in diastolic BP at commonly used dosages. A randomized clinical trial comparing the two combinations is needed to confirm these findings.

Role of olmesartan in combination therapy in blood pressure control and vascular function

“…These findings are in agreement with other studies documenting the efficacy of the combination of olmesartan/HCTZ in subjects with hypertension and in those with isolated systolic hypertension 44,58–60. As reviewed by Quan et al61 a multi-factorial analysis of the published studies reported that the daily combination of 40 mg olmesartan and 25 mg HCTZ produced greater blood pressure reductions than with the administration of 300 mg irbesartan/25 mg HCTZ, 80 mg telmisartan/12.5 mg HCTZ, and 160 mg valsartan/25 mg HCTZ 62. The addition of HCTZ to patients receiving a fixed-dose combination of olmesartan/amlodipine (40/5–10 mg/day) increased the overall proportion of patients reaching the goal blood pressure 63.…”

Efficacy and Safety of Olmesartan Medoxomil and Hydrochlorothiazide Compared with Benazepril and Amlodipine Besylate

“…[3] In the The ARB olmesartan medoxomil has antihypertensive efficacy UKPDS (United Kingdom Prospective Diabetes Study) 38 trial, that compares favorably with atenolol, captopril, felodipine, and 29% of those subjects assigned to a BP target of <150/85mm Hg amlodipine besylate, as well as other ARBs. [17] to be adjusted, or a second drug added, to achieve their target [2] Both the JNC 7 (Seventh Report of the in SBP and DBP than monotherapy with either agent alone in a Joint National Committee on Prevention, Detection, Evaluation, randomized trial.…”

Efficacy and Safety of Olmesartan Medoxomil in Patients with Stage 1 Hypertension: Blood Pressure Lowering and Goal Achievement

“…4 However, these metabolic effects may be attenuated via combination with an ARB. 29,30 Furthermore, in asymptomatic patients with hypertension, particularly in elderly patients, there is evidence for a weaker cardioprotective effect and reduced benefits in cerebrovascular and renal outcomes with β-blockers such as atenolol. 4 There are currently no meaningful data for comparisons of tolerability between OM and other ARBs in patients with stage 1 hypertension, but given the high tolerability within the ARB class, meaningful differences in tolerability are not expected.…”