Comparison of combination therapies, including the angiotensin receptor blocker olmesartan and either a calcium channel blocker or a thiazide diuretic, in elderly patients with hypertension

Abstract

The blood pressure goals set for the treatment of hypertensive patients have been lowered in recent guidelines. To reduce blood pressure levels sufficiently, combination therapies are often needed, but there is little evidence about which combination should be chosen. The present study was carried out to compare the effects of combination therapies, including the angiotensin receptor blocker olmesartan and either a calcium channel blocker (CCB) or a thiazide diuretic, in elderly patients with hypertension. A total of 65 patients aged 65-85 years, with blood pressures of 140/90 mm Hg or higher for those taking antihypertensive medication or 160/100 mm Hg or higher for those not on medication, were randomly assigned to either the group treated with olmesartan plus a dihydropyridine CCB or the group treated with olmesartan plus a thiazide diuretic; 58 patients completed the treatment for 6 months. Systolic and diastolic blood pressures (SBP and DBP) were reduced during the treatment period in both the groups. The reductions in SBP at 1 and 6 months were significantly (Po0.05) greater in the CCB combination group than in the diuretic group (À29 vs. À18 mm Hg, respectively, at 1 month; À32 vs. À23 mm Hg, respectively, at 6 months). Despite greater reduction in SBP in the CCB group, the serum creatinine level and the estimated glomerular filtration rate (eGFR) remained unchanged, whereas in the diuretic group, creatinine was elevated (+0.06 mg per 100 ml, Po0.05) and eGFR was reduced (À4.5 ml min À1 per 1.73 m 2 ). In addition, high-density lipoprotein cholesterol levels were reduced in the diuretic group (À5.0 mg per 100 ml, Po0.01). These results suggest that olmesartan plus a CCB is the preferable combination therapy in comparison with olmesartan plus a thiazide diuretic for elderly patients with hypertension.

Combination of antihypertensive therapy in the elderly, multicenter investigation (CAMUI) trial

“…According to the report of Shimosawa et al [22] combination therapy with losartan (50 mg)/hydrochlorothiazide (12.5 mg) and candesartan (8 mg)/amlodipine (5 mg), showed similar efficacy in blood pressure reduction. On the contrary, the study by Kato et al [23], whose participants were elderly patients with hypertension aged 65-85 years, showed a similar time course of the blood pressure until 6 months and the reductions in the SBP at 1 and 6 months were significantly greater in the CCB combination group than in the diuretic combination group, which was comparable to our study. Although the attainment speed of the BP goal in the two groups was different, the slow attainment in the ARB/HCTZ (12.5 mg) group might not be disadvantageous for elderly hypertensive patients as it reached the same level at 6 months.…”

Renoprotective effects of renin–angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients

“…The final 14 RCTs consisted of a total of 18,125 patients with hypertension. Among them, 8 RCTs recruited Asian subjects only, [ 13 – 15 , 18 , 20 , 21 , 23 , 24 ] while the other 6 RCTs were conducted in either mixed-race or unmentioned-race populations. Six RCTs compared the 2 combined treatments in 1001 patients with diabetes mellitus, [ 13 , 14 , 16 , 17 , 22 , 25 ] and 3 RCTs compared treatments in 1079 CKD patients.…”

“…The assessment of quality and risk of bias are summarized in Table 1 . Five studies obtained Jadad scores lower than 3, [ 15 , 16 , 18 , 20 , 24 ] indicating low quality. The Cochrane Collaboration assessment suggested that 8 studies were at a high risk of bias [ 12 , 14 – 16 , 18 , 20 , 23 , 24 ] (Table 1 ).…”

“…Seven trials reported the change in eGFR [ 13 – 15 , 19 , 20 , 23 , 25 ] and 2 trials reported the change in CrCl. [ 16 , 17 ] Four showed that ACEI/ARB plus CCB was the better treatment choice than ACEI/ARB plus diuretic, [ 13 , 14 , 19 , 25 ] whereas the remaining 5 studies showed no difference between the 2 treatment strategies.…”

Hydrochlorothiazide Versus Calcium Channel Blockers: What is the Best Add-on to a Renin-Angiotensin System Blocker for Treating Hypertension in Patients with Renal Disease?

“…Another recently published study [43] compared a combination of an ARB with a DHP-CCB versus an ARB with a diuretic. In this study, the authors showed greater reduction in SBP in patients receiving olmesartan and amlodipine compared with those receiving olmesartan and HCTZ.…”