Critical appraisal of amlodipine and olmesartan medoxomil fixed-dose combination in achieving blood pressure goals

Abstract

Hypertension remains a significant health burden in the United States, with almost one in three adults affected, and is an independent risk factor for cardiovascular and renal disease. The goal of antihypertensive treatment is to reduce cardiovascular and renal morbidity and mortality by reducing blood pressure (BP). Guidelines recommend a target BP of <140/90 mmHg, with a more stringent goal of <130/80 mmHg for patients with diabetes and chronic renal disease. However, BP goal attainment rates remain low and most patients require therapy with two or more antihypertensive agents. Combination antihypertensive therapy usually employs agents from different classes, thus benefitting from complementary mechanisms of action to achieve greater BP control with fewer side effects. Patient adherence to therapy is enhanced by formulating treatments as fixed-dose (single-pill) combinations. One example is the combination of amlodipine, a dihydropyridine calcium channel blocker (CCB), with olmesartan medoxomil, an angiotensin receptor blocker (ARB). Here, the rationale for the use of CCB/ARB combination therapy is discussed, as well as the pharmacology and tolerability of the amlodipine/olmesartan medoxomil combination and its efficacy in terms of achieving BP goal in patients with hypertension. Advantages of its use from the patient’s perspective are also discussed.

Could the polypill improve adherence? The patient perspective

“…Other studies have reported that fixed-dose combinations offer advantages of convenience. 7,18 The literature correlates well with the findings in this research and it appears to be generally accepted that the use of a combination pill will improve the convenience of taking regular medication, leading to greater adherence to regimens and improved health outcomes.…”

Fixed-dose combination of nifedipine gastrointestinal therapeutic system and candesartan cilexetil in patients with moderate-to-severe essential hypertension: an open-label, long-term safety and efficacy study

“…2 Review of other CCB/ARB FDCs in mild-to-severe hypertension, including amlodipine/olmesartan and amlodipine/telmisartan, supports the simplified fixed-dose approach in long-term therapy, with benefits for safety, efficacy and compliance relative to monotherapies. 20,21 We are aware of no long-term clinical studies in hypertension that directly compare the efficacy and safety of different CCB/ARB FDCs.…”