奥美沙坦酯与缬沙坦对原发性高血压患者血压晨峰的影响

目的比较奥美沙坦酯和缬沙坦治疗高血压患者血压晨峰的疗效。方法选择我院76例原发性高血压患者随机分为2组,分别接受奥美沙坦酯20-40mg／d或缬沙坦80-160mg／d治疗,共8周,观察服药前及服药后清晨血压变化。结果奥美沙坦酯组和缬沙坦组治疗后晨峰血压均有明显下降,与治疗前比较差异有统计学意义（P〈0．05）。奥美沙坦酯组和缬沙坦组晨峰血压下降的幅度分别为：／kSBP（10．22±0．35）mmHg、（5．63±0．21）mmHg;△DBP（7．71±0．29）mmHg、（3．55±0．14）mmHg,奥美沙坦酯组血压晨峰下降幅度高于缬沙坦组,差异有统计学意义（P〈0．05）。结论奥美沙坦酯和缬沙坦均可以有效地控制原发性高血压患者血压晨蜂现象,奥美沙坦酯优于缬沙坦。     

奥美沙坦酯治疗老年单纯收缩期高血压的疗效及安全性观察

目的观察血管紧张素Ⅱ受体拮抗剂奥美沙坦酯治疗老年单纯收缩期高血压（ISH）的疗效和安全性。方法将60例老年ISH患者随机分为氯沙坦组（30例）与奥美沙坦酯组（30例）,分别经空白洗脱2周后,患者每日口服1次氯沙坦50mg或奥美沙坦酯20mg,每2周观察血压、心率变化及不良反应的发生情况;比较治疗前后血尿常规、血生化指标及心电图改变。结果治疗8周后,两组收缩压均显著下降（P〈0．05）,但奥美沙坦酯组SBP下降幅度优于氯沙坦组（P〈0．05）,且降压总有效率（86．67％）也优于氯沙坦组（76．67％,P〈0．05）。结论奥美沙坦酯能有效降低老年ISH患者的血压,疗效优于氯沙坦,具有良好的安全性。     

厄贝沙坦与氯沙坦治疗轻、中度高血压病的比较

目的 比较厄贝沙坦与氯沙坦对轻中度高血压病患者的降压疗效。方法 采用随机、双盲研究方法。经2周的单盲、安慰剂导入期,72例坐位舒张压在95－115mmHg之间的高血压患者被随机分入厄贝沙坦75mg/天组（n=36)或氯沙坦50mg/天组（n=36)。4周末,如坐位舒张仍≥90mmHg,每日剂量加倍（厄贝沙坦150mg/天或氯沙坦100mg／天）,总疗程8周。结果 两组患者服药后血压均显著降低（P＜0．01）。经8周治疗,厄贝沙坦组平均坐位收缩压与舒张压分别降低15．0％与13．3％,在氯沙坦组分别为13．7％与14．0％。两药的有效率无显著性差别（厄贝沙坦75．0％,氯沙坦71．4％,P＞0．05）。与厄贝沙坦不同,氯沙坦组血尿酸水平显著降低。结论 在轻中度高血压的治疗中,厄贝沙坦与氯沙坦一样有效与安全。     

血管紧张素转化酶基因I／D多态性与奥美沙坦酯降压疗效的临床研究

目的：探讨血管紧张素转化酶（ACE）基因I／D多态性与奥美沙坦酯降压疗效的关系。方法：高血压患者服用奥美沙坦酯8周,在观察降压疗效的同时,用PCR—RFLP方法对患者血白细胞基因组DNA多态性位点ACEI／D基因型进行检测;按不同ACE基因型进行分组,比较不同基因型患者的血压下降值、降压总有效率的差异。结果：ACE基因ID＋DD基因型和II基因型患者使用奥美沙坦酯8周后收缩压下降幅度分别为16．23±6．51mmHg（2．164±0．868kPa,1kPa=7．5mmHg）、5．10±8．66mmHg,降压总有效率分别为81．25％、33．34％,组间比较有统计学差异（P〈0．05）;舒张压下降幅度分别为13．34±7．25mmHg、6．21±5．29mmHg,组间比较无统计学差异（P〉0．05）。结论：ACE基因ID＋DD基因型高血压患者对奥美沙坦酯降压治疗较敏感。     

奥美沙坦酯与左旋氨氯地平合用对高血压蛋白尿的作用

目的观察奥美沙坦酯与左旋氨氯地平联合应用对高血压患者蛋白尿的临床疗效。方法将90例高血压合并肾脏损害蛋白尿的患者随机分为A、B两组。A组给予奥美沙坦酯20mg／d和左旋氨氯地平2．5mg／d,B组给予左旋氨氯地平2．5mg／d和氢氯噻嗪12．5mg／d,控制血压及消退蛋白尿,均治疗6个月。观察两组治疗前后血压、24h尿白蛋白总量的变化。结果治疗6个月后,A、B两组血压明显下降（P〈0．01）,A组下降[（28．1±1．9）／（32．6±3．9）mmHg]与B组下降[（27．8±3．1）／（31．8±1．7）mmHg]比较差异无统计学意义（P〉0．05）。A、B两组尿蛋白均下降,但A组下降[（0．79±0．09）g／24h]较B组[（0．41±0．13）g／24h]下降更明显,差异有统计学意义（P〈0．01）。结论奥美沙坦酯与左旋氨氯地平合用能较平稳降低血压,显著减少尿蛋白,有效保护肾脏。     

伊贝沙坦治疗轻中度高血压疗效和安全性的临床研究

目的　为评价新一代血管紧张素ⅡAT1受体拮抗剂伊贝沙坦 (安博维 )降压疗效及安全性 ,并与氯沙坦相比较。方法　采用随机分组平行对照方法 ,将 12 0例轻、中度高血压患者分成伊贝沙坦组(6 0例 ) ,口服 15 0mg·d- 1和氯沙坦组 (6 0例 ) ,口服 5 0mg·d- 1。观察 8周。每 2周一次上午延迟 1～ 4小时用药并测诊室谷值坐位血压、心率 ,并观察不良反应。用药前及治疗第 4周和第 8周检测血液生化。第 4周谷值坐位血压仍大于 90mmHg者加用双氢克尿噻 12 5mg·d- 1。结果　第 4周伊贝沙坦与氯沙坦正常化率分别为 4 0 %和 35 % ,第 8周伊贝沙坦与氯沙坦组血压有效反应率分别为 78 3%和6 6 7% ,(P >0 0 5 )。两组治疗前、后平均谷值坐位舒张压有显著性差异P <0 0 1。伊贝沙坦组不良反应发生率 6 6 % ,氯沙坦组为 8 3% (P >0 0 5 )。两组部分病例加用小剂量双氢克尿噻后 ,谷值坐位舒张压进一步下降。谷值坐位舒张压下降幅度 ,伊贝沙坦组优于氯沙坦组 ,P <0 0 5。结论　伊贝沙坦与氯沙坦不良反应发生率均较低 ,伊贝沙坦降低谷值坐位舒张压更有效。建议生产伊贝沙坦与小剂量双氢克尿噻的复方制剂     

奥美沙坦酯与苯磺酸氨氯地平治疗高血压晨峰血压的疗效对比

目的:评价奥美沙坦治疗高血压晨峰血压(MBPS)的疗效。方法:103例原发性高血压MBPS患者随机分为2组,分别接受奥美沙坦(53例,20 mg/d)和苯磺酸氨氯地平(50例,5 mg/d)治疗8周,于治疗前和治疗后4、8周做24 h动态血压监测,调整药物剂量和观测服药前后清晨血压变化。结果:2组药物治疗8周,24 h、白天、夜间及最后2~4 h平均血压均降至正常范围。奥美沙坦组最后2~4 h舒张压(DBP)的降低幅度大于氨氯地平组(19.3±11.8 vs 9.0±6.6 mmHg,P=0.031)。2组降晨峰血压(MBPS)的幅度相近,△收缩压(15.8±6.7 vs 17.0±6.8 mmHg,P0.05);△舒张压(12.8±5.9 vs 9.3±2.1 mmHg,P0.05)。2组治疗后脉率均稍有上升(3.4±1.8 vs 4.2±1.3次/min,P0.05)。2组治疗后收缩压和舒张压的平滑指数(SI)无统计学差异。结论:奥美沙坦酯能有效平稳的控制原发性高血压MBPS,奥美沙坦能强效抑制清晨舒张压的波动。     

伊贝沙坦治疗轻中度高血压疗效和安全性的临床研究

目的为评价新一代血管紧张素Ⅱ AT1受体拮抗剂伊贝沙坦(安博维)降压疗效及安全性,并与氯沙坦相比较.方法采用随机分组平行对照方法,将120例轻、中度高血压患者分成伊贝沙坦组(60例),口服150mg*d-1和氯沙坦组(60例),口服50 mg*d-1.观察8周.每2周一次上午延迟1～4小时用药并测诊室谷值坐位血压、心率,并观察不良反应.用药前及治疗第4周和第8周检测血液生化.第4周谷值坐位血压仍大于90 mmHg者加用双氢克尿噻12.5 mg*d-1.结果第4周伊贝沙坦与氯沙坦正常化率分别为40%和35%,第8周伊贝沙坦与氯沙坦组血压有效反应率分别为78.3%和66.7%,(P＞0.05) .两组治疗前、后平均谷值坐位舒张压有显著性差异P＜0.01.伊贝沙坦组不良反应发生率6.6%,氯沙坦组为8.3% (P>0.05).两组部分病例加用小剂量双氢克尿噻后,谷值坐位舒张压进一步下降.谷值坐位舒张压下降幅度,伊贝沙坦组优于氯沙坦组,P＜0.05.结论伊贝沙坦与氯沙坦不良反应发生率均较低,伊贝沙坦降低谷值坐位舒张压更有效.建议生产伊贝沙坦与小剂量双氢克尿噻的复方制剂.     

氯沙坦钾和盐酸苯那普利对老年高血压患者疗效的比较

目的：比较氯沙坦钾和盐酸苯那普利对老年高血压患者的降压疗效和安全性。方法：70例轻中度高血压者随机选用氯沙坦钾50mg或盐酸苯那普利10mg，每日一次口服，共24周。24h动态血压监测血压的改变。结果：共62例完成随访。氯沙坦钾组（n=35）治疗后总体SBP和DBP较治疗前下降9．05mmHg和4．89mmHg；盐酸苯那普利组（n=27）治疗后总体SBP和DBP较治疗前下降7．19mmHg和4．89mmHg；盐酸苯那普利组（n=27）治疗后总体SBP和DBP较治疗前下降7．19mmHg和2．00mmHg，有效率分别为51．43％和51．85％，两组无显著性差别。随访的老年高血压患者治疗期间无一例发生心脑血管事件。氯沙坦钾组中咳嗽发生率占2．86％，低于盐酸苯那普利组的25．93％。结论：氯沙坦钾治疗老年轻中度高血压和盐酸苯那普利均有效，安全性好且耐受性于盐酸苯那普利。     

奥美沙坦酯治疗轻度及中度原发性高血压疗效和安全性的评价

目的:评价奥美沙坦酯治疗轻度及中度原发性高血压的疗效和安全性。方法:80例轻度及中度原发性高血压患者随机接受奥美沙坦酯20 mg或缬沙坦80 mg治疗,每日1次,总疗程8周。结果:奥美沙坦酯组治疗前的收缩压(SBP)/舒张压(DBP)为(155.2±11.4)/(96.1±5.2)mmHg(1 mmHg=0.133 kPa),治疗后的血压为(138.8±10.2)/(86.5±4.8)mmHg,血压下降幅度为(16.4±8.1/9.6±5.1)mmHg。缬沙坦组治疗前的SBP/DBP为(156.1±12.2)/(97.2±5.1)mmHg,治疗后的血压为(139.5±10.4)/(88.0±5.5)mmHg,血压下降幅度为(15.6±7.8/9.1±4.9)mmHg。2组治疗前后血压下降幅度差异均有统计学意义(P<0.01),2组间差异无统计学意义(P>0.05)。奥美沙坦酯组和缬沙坦组降压显效率分别为59.0%和60.5%,总有效率分别为87.2%和86.8%,2组间差异无统计学意义。本实验中奥美沙坦酯组出现不良反应者少。结论:奥美沙坦酯治疗轻度及中度原发性高血压疗效确切,且安全可靠。     

Comparison of increasing doses of olmesartan medoxomil, losartan potassium, and valsartan in patients with essential hypertension

This 12-week, randomized, double-blind, forced-titration study compared the efficacy of 3 angiotensin receptor blockers. Patients received olmesartan medoxomil 20 mg, losartan potassium 50 mg, valsartan 80 mg, or placebo once daily. At week 4, doses were titrated to 40, 100, and 160 mg once daily for olmesartan, losartan, and valsartan, respectively. At week 8, losartan was increased to 50 mg twice daily and valsartan increased to 320 mg once daily (olmesartan remained at 40 mg once daily). The primary end point was mean change from baseline in seated diastolic blood pressure (SeDBP) at week 8. All 3 medications significantly reduced mean SeDBP from baseline compared with placebo at weeks 4, 8, and 12 (P<.001). At week 8, olmesartan reduced mean SeDBP more than losartan (P<.001); more patients in the olmesartan medoxomil group achieved a blood pressure goal of <140/90 mm Hg (P<.001). Olmesartan did not reduce mean SeDBP significantly compared with valsartan, although more patients attained blood pressure goal with olmesartan (P=.031). At week 12, all agents lowered blood pressure equivalently.     

Evaluation of antihypertensive therapy with the combination of olmesartan medoxomil and hydrochlorothiazide

BACKGROUND: Most patients with hypertension require more than one agent to control blood pressure (BP). The purpose of this study was to assess the efficacy and safety of the angiotensin II receptor blocker olmesartan medoxomil in combination with hydrochlorothiazide (HCTZ). METHODS: This was a randomized, double-blind, factorial design study. After a placebo run-in period, eligible patients (n = 502) with a baseline mean seated diastolic blood pressure (SeDBP) of 100 to 115 mm Hg were randomized to one of 12 groups: placebo, olmesartan medoxomil monotherapy (10, 20, or 40 mg/day, HCTZ monotherapy (12.5 or 25 mg/day), or one of six groups of olmesartan medoxomil/HCTZ combination therapy. The primary endpoint was the change in mean trough SeDBP from baseline at week 8. Statistical analyses were conducted to determine whether at least one combination produced a larger reduction in SeDBP at week 8 than the individual corresponding component doses, but did not compare BP reductions with different combination doses. RESULTS: Olmesartan medoxomil plus HCTZ produced greater reductions in both SeDBP and seated systolic blood pressure (SeSBP) at week 8 than did monotherapy with either component. All olmesartan medoxomil/HCTZ combinations significantly reduced SeDBP and SeSBP compared with placebo in a dose-dependent manner. Reductions from baseline in mean trough SeSBP/SeDBP were 3.3/8.2 mm Hg, 20.1/16.4 mm Hg, and 26.8/21.9 mm Hg with placebo, olmesartan medoxomil/HCTZ 20/12.5 mg, and olmesartan medoxomil/HCTZ 40/25 mg, respectively. All treatments were well tolerated. CONCLUSIONS: Olmesartan medoxomil/HCTZ combination therapy produced BP reductions of up to 26.8/21.9 mm Hg and was well tolerated.     

国产与进口奥美沙坦酯对轻中度原发性高血压患者降压疗效与安全性的比较

目的通过与进口奥美沙坦酯比较,评价国产奥美沙坦酯治疗轻中度原发性高血压患者的疗效和安全性。方法采用随机、双盲、双模拟、阳性对照、多中心临床试验方法。入选轻中度原发性高血压患者222例,按11比例随机分为试验组110例和对照组112例,分别接受国产或进口奥美沙坦酯20mg口服治疗。4周后如诊室坐位血压<140/90mm Hg(1mm Hg=0.133kPa)则维持原剂量;血压未达标者加量至国产奥美沙坦酯40mg+安慰剂2片,或进口奥美沙坦酯40mg+安慰剂2片,服药至8周末。在基线和第8周时分别进行24h动态血压监测,观察治疗前后血压变化。结果与基线比较,治疗4周后,试验组与对照组诊室坐位血压平均降幅分别为(20.24±13.13)/(15.03±6.79)mm Hg vs(18.66±10.41)/(14.24±5.90)mm Hg;8周后分别为(22.50±11.61)/(16.57±6.33)mm Hg vs(21.78±11.24)/(16.08±6.02)mm Hg,差异无统计学意义(P>0.05)。治疗8周后,试验组与对照组24h血压平均降幅分别为(8.8±3.0)/(10.8±2.8)mm Hg vs(8.9±4.0)/(9.2±4.2)mm Hg,差异无统计学意义(P>0.05)。结论轻中度原发性高血压患者服用国产奥美沙坦酯治疗能有效、安全地降低血压,其降压幅度及平稳性与进口奥美沙坦酯相似。     

Effects of high dose olmesartan medoxomil plus hydrochlorothiazide on blood pressure control in patients with grade 2 and grade 3 hypertension

High dose (40 mg) olmesartan medoxomil (OM) blocks the angiotensin II receptor, significantly reducing blood pressure (BP). Adding hydrochlorothiazide (HCTZ) to OM increases efficacy, but has not been evaluated in patients inadequately controlled by OM 40 mg. Patients with grade 2 and grade 3 hypertension with inadequately controlled BP (seated diastolic blood pressure [SeDBP] 90-115 mm Hg and seated systolic blood pressure [SeSBP] 140-180 mm Hg, plus ambulatory BP criteria) after 8 weeks of OM 40 mg open-label treatment were randomized to 8 weeks of double-blind treatment with OM/HCTZ 40/25 (n=140), 40/12.5 (n=278), 20/12.5 mg (n=280) or OM 40 mg (n=274). Treatment with OM/HCTZ 40/25 mg and 40/12.5 mg significantly reduced SeDBP (-5.3 and -3.4 mm Hg, respectively), and SeSBP (-7.4 and -5.2 mm Hg, respectively), vs OM 40 mg monotherapy (P<0.0001 for each) in patients inadequately controlled on OM 40 mg alone. OM/HCTZ 40/12.5 mg reduced SeSBP significantly more than OM/HCTZ 20/12.5 mg (-2.6 mm Hg, P=0.0255), and also produced a further reduction in SeDBP vs the lower dose. All treatments were well tolerated, with similar low proportions of patients reporting treatment-emergent adverse events in all treatment groups. In conclusion, adding HCTZ to OM 40 mg significantly improves BP reductions and target BP rates in harder-to-treat patients and a clear dose-response was observed for efficacy.     

氯沙坦及氯沙坦与双氢克尿噻合剂对原发性高血压患者肾素活性影响的比较

目的比较血管紧张素Ⅱ受体拮抗剂氯沙坦及氯沙坦与双氢克尿噻合剂对原发性高血压患者的降压疗效和肾素活性水平的影响。 方法坐位舒张压95～115mmHg(1mmHg=0.133kPa)的76例原发性高血压患者,经1周药物洗脱期,2周安慰剂期后,随机服用氯沙坦50mg(氯沙坦组,n=37),每日1次或氯沙坦50mg与双氢克尿噻12.5mg合剂(氯沙坦+双氢克尿噻合剂组,n=39),每日1次。4周末坐位舒张压≥90mmHg者,剂量分别加倍,继续服用4周。于安慰剂期末及服药8周末测量诊室坐位血压和测定立位血浆肾素活性水平。 结果服药8周末平均坐位舒张压氯沙坦组(n=35)下降10.1±9.1mmHg;氯沙坦+双氢克尿噻合剂组(n=33)下降14.6±7.5mmHg(组间比较P＜0.05);同时服用末次药24小时后氯沙坦组的平均血浆肾素活性从1.6ng/(ml*h)增加至5.4ng/(ml     

Antihypertensive Efficacy of Olmesartan Medoxomil, a New Angiotensin II Receptor Antagonist, as Assessed by Ambulatory Blood Pressure Measurements

Olmesartan medoxomil is a new angiotensin II receptor blocker. In this randomized, double-blind, placebo-controlled study, the efficacy and safety of olmesartan medoxomil was assessed in 334 patients with moderate to severe essential hypertension. Patients were randomized to receive placebo; 5, 20, or 80 mg olmesartan medoxomil q.d.; or 2.5, 10, or 40 mg olmesartan medoxomil b.i.d. Ambulatory and cuff blood pressure were measured prior to and after 8 weeks of treatment. Treatment with olmesartan medoxomil resulted in a significant placebo-adjusted reduction of mean 24-hour ambulatory diastolic blood pressure of 9.6 mm Hg, 12.2 mm Hg, and 10.6 mm Hg in the 5-, 20-, and 80-mg q.d. groups, respectively. Corresponding reductions in mean ambulatory systolic blood pressure were 14.5 mm Hg, 16.5 mm Hg, and 15.4 mm Hg. Similar reductions of diastolic and systolic blood pressure were seen with b.i.d. dosing. The diastolic trough-to-peak ratios of the q.d. doses of olmesartan medoxomil ranged from 57%–70%, indicating 24-hour effectiveness. The safety profile of olmesartan medoxomil was similar to that of placebo. Olmesartan medoxomil appears to be a safe and effective once-a-day treatment for hypertension.     

Antihypertensive efficacy of olmesartan medoxomil,a new angiotensin II receptor antagonist,as assessed by ambulatory blood pressure measurements

Olmesartan medoxomil is a new angiotensin II receptor blocker. In this randomized, double-blind, placebo-controlled study, the efficacy and safety of olmesartan medoxomil was assessed in 334 patients with moderate to severe essential hypertension. Patients were randomized to receive placebo; 5, 20, or 80 mg olmesartan medoxomil q.d.; or 2.5, 10, or 40 mg olmesartan medoxomil b.i.d. Ambulatory and cuff blood pressure were measured prior to and after 8 weeks of treatment. Treatment with olmesartan medoxomil resulted in a significant placebo-adjusted reduction of mean 24-hour ambulatory diastolic blood pressure of 9.6 mm Hg, 12.2 mm Hg, and 10.6 mm Hg in the 5-, 20-, and 80-mg q.d. groups, respectively. Corresponding reductions in mean ambulatory systolic blood pressure were 14.5 mm Hg, 16.5 mm Hg, and 15.4 mm Hg. Similar reductions of diastolic and systolic blood pressure were seen with b.i.d. dosing. The diastolic trough-to-peak ratios of the q.d. doses of olmesartan medoxomil ranged from 57%-70%, indicating 24-hour effectiveness. The safety profile of olmesartan medoxomil was similar to that of placebo. Olmesartan medoxomil appears to be a safe and effective once-a-day treatment for hypertension.     

Clinical and Experimental Aspects of Olmesartan Medoxomil,a New Angiotensin II Receptor Antagonist

Olmesartan medoxomil is a new orally active angiotensin II (Ang II) type 1 receptor antagonist. It is a prodrug and is rapidly de‐esterified during absorption to form olmesartan, the active metabolite. Olmesartan is a potent, competitive and selective Ang II type 1 receptor antagonist. Olmesartan is not metabolized by the cytochrome P‐450 and has a dual route of elimination, by kidneys and liver. In patients with essential hypertension olmesartan medoxomil administered once daily at doses of 10–80 mg dose‐dependently reduced diastolic blood pressure (DBP). Troughto‐peak ratios for both DBP and systolic blood pressure (SBP) were above 50%. At the recommended once‐daily starting doses, olmesartan medoxomil (20 mg) was more effective than losartan (50 mg), valsartan (80 mg) or irbesartan (150 mg) in reducing cuff DBP in patients with essential hypertension. The results of cuff SBP and mean 24‐h DBP and SBP were similar to those of cuff DBP measurement. In mild‐to‐moderate hypertensive patients the recommended starting dose of olmesartan medoxomil was as effective as that of amlodipine besylate (5 mg/day) in reducing both cuff and 24‐h blood pressure. In lowering DBP olmesartan medoxomil, at 10–20 mg/day, was as effective as atenolol at 50–100 mg/day. In mild‐to‐moderate hypertensive patients, olmesartan medoxomil, at 5–20 mg once daily, was more effective than captopril at 12.5–50 mg twice daily. At 20–40 mg once daily olmesartan medoxomil was as effective as felodipine, at 5–10 mg once daily. Olmesartan medoxomil has minimal adverse effects with no clinically important drug interactions. Animal studies have shown that olmesartan medoxomil provides a wide range of organ protection. Olmesartan medoxomil ameliorated atherosclerosis in hyperlipidemic animals and ameliorated cardiac remodeling and improved survival in rats with myocardial infarction. Olmesartan medoxomil has renoprotective effects in a remnant kidney model and type 2 diabetes models. Future investigation should reveal whether these beneficial effects of olmesartan medoxomil are applicable to human diseases.     

Antihypertensive efficacy of olmesartan compared with other antihypertensive drugs

The therapeutic profile of olmesartan medoxomil, which is a recently developed angiotensin II (A II) receptor blocker, has been compared with four commonly used antihypertensive therapeutic drugs (atenolol, captopril, felodipine and losartan) in five separate multicentre, randomised, double-blind, parallel-group, phase III trials. The trials were designed to compare the efficacy of individually optimised dosages of olmesartan medoxomil and the comparator agent. The primary efficacy variable in all trials was the mean change from baseline to week 12 in trough mean sitting diastolic blood pressure (DBP). Olmesartan medoxomil (10-20 mg once daily (o.d.)) showed similar efficacy to atenolol (50-100 mg o.d.), both in patients with mild-to-moderate hypertension and, when given together with hydrochlorothiazide (HCTZ) 25 mg o.d., in patients with moderate-to-severe hypertension. Olmesartan medoxomil (20-40 mg o.d.) was also similar in efficacy to felodipine (5-10 mg o.d.) in reducing BP in patients with mild-to-moderate hypertension. Compared with captopril (12.5-50 mg twice daily (b.i.d.)) and losartan (50-100 mg o.d.), in patients with mild-to-moderate hypertension, olmesartan medoxomil (5-20 mg o.d. and 10-20 mg o.d., respectively) was significantly superior in terms of lowering DBP from baseline to week 12. In terms of the secondary efficacy variable, which was mean change from baseline to week 12 in trough mean sitting systolic BP, olmesartan showed significant superiority to atenolol, captopril and losartan in patients with mild-to-moderate hypertension. In the longer term, compared with losartan, a lower percentage of olmesartan-treated patients required concomitant HCTZ after 12 weeks of therapy. Olmesartan was well tolerated in all studies.