Efficacy and safety of treating stage 2 systolic hypertension with olmesartan and olmesartan/HCTZ: results of an open-label titration study

This study investigated an aggressive treatment program for stage 2 systolic hypertension (pretreatment systolic blood pressure [SBP] > or = 160 mm Hg) using the angiotensin receptor blocker olmesartan medoxomil (OM) and hydrochlorothiazide (HCTZ). In this open-label, 16-week trial, 170 subjects received OM 20 mg/d for 3 weeks. If seated SBP/diastolic BP remained > or = 120/80 mm Hg, subjects were advanced to successive 3-week courses of OM 40 mg/d, OM/HCTZ 40/12.5 mg/d, and OM/HCTZ 40/25 mg/d. OM 20 mg/d reduced mean SBP by 16.9 mm Hg (P<.001), and there were further dose-dependent decreases in mean SBP to a maximum of 34.5 mm Hg with OM/HCTZ 40/25 mg/d. At study end, 75.1% of subjects achieved SBP goal (<140 mm Hg) and 16.0% achieved SBP normalization (<120 mm Hg). Treatment was well tolerated at all doses. The addition of HCTZ did not change serum potassium levels but resulted in a dose-independent but not symptomatic increase in serum glucose and uric acid. The authors conclude that an OM-based regimen, with or without HCTZ in conventional doses, is effective in controlling and normalizing BP in stage 2 systolic hypertension.     

Management of hypertension in patients with diabetes mellitus

OBJECTIVE:

To investigate the management of hypertension in patients with diabetes mellitus, living in a rural setting.

METHOD:

A community health screening clinic was conducted at Charles Sturt University, Albury-Wodonga, in rural southeastern Australia. Patients with either diagnosed hypertension or high blood pressure who attended the clinic were eligible for inclusion in the present study. The awareness and control of hypertension was compared between patients with and without diabetes mellitus.

RESULTS:

A total of 449 patients with hypertension were analyzed. One hundred twenty-one (26.9%) had hypertension and diabetes mellitus, and 328 (73.1%) had hypertension without diabetes mellitus. Hypertension awareness (61.2% versus 36.9%, P=0.014) and control (17.4% versus 7.0%, P=0.040) were significantly better in the hypertensive patients with diabetes mellitus than in the hypertensive patients without diabetes mellitus. Antihypertensive medication use was also significantly higher in patients with diabetes mellitus than in patients without diabetes mellitus (one antihypertensive medication, 41.3% versus 25.0%, P=0.045).

CONCLUSION:

Awareness and control of hypertension were suboptimal in the patients in the present study. Diabetes mellitus, however, was associated with both higher awareness and better control of hypertension than having hypertension alone. This may be partially due to a higher use of antihypertensive medications by patients with diabetes mellitus.     

奥美沙坦对高血压合并冠心病和糖尿病患者血管内皮功能的保护作用

目的通过检测奥美沙坦用药前后患者血管内皮功能的变化,探讨奥美沙坦对于高血压病合并冠心病和糖尿病患者血管内皮功能的保护作用。方法收集符合条件的高血压患者160例,根据是否合并冠心病和糖尿病分为3组:单纯高血压组(H组,n=40)、高血压合并冠心病组(HC组,n=62)、高血压合并冠心病和糖尿病组(HCD组,n=58),然后再将各组平均分为2个亚组:奥美沙坦干预亚组(A亚组)、非奥美沙坦干预亚组(B亚组)。统计各组基线资料及一般检查指标,用酶联免疫吸附试验检测血清一氧化氮和内皮素1的浓度,并用流式细胞术检测外周血内皮祖细胞(EPC)数量;奥美沙坦干预3个月后复查。结果 (1)血管内皮舒缩因子:用药前,与H组比较,HC组、HCD组的一氧化氮浓度均明显降低,而内皮素1浓度均明显升高,且HCD组变化更明显(P0.05);用药后,与用药前比较,HC-A亚组、HCD-A亚组的一氧化氮浓度均明显升高,而内皮素1浓度均降低(P0.05)。(2)外周血EPC数量:用药前,与H组比较,HC组、HCD组的外周血EPC数量均减少,且HCD组减少更明显(P0.05);用药后,与用药前比较,HC-A亚组、HCD-A亚组的EPC数量升高(P0.05)。结论高血压患者合并冠心病和糖尿病时会加重血管内皮的损害。奥美沙坦可以抑制血管内皮舒缩因子失衡,并提高外周血EPC数量,具有血管内皮保护作用。     

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。     

Efficacy of amlodipine and olmesartan medoxomil in hypertensive patients with diabetes and obesity

A subgroup analysis of a prospective, open-label, single-arm titration study in patients with hypertension and type 2 diabetes or obesity is reported. The primary end point was the change from baseline in mean 24-hour ambulatory systolic blood pressure (BP) after 12 weeks. Patients received amlodipine 5 mg/d and were uptitrated (if seated [Se] BP was ≥ 120/80 mm Hg) at 3-week intervals to amlodipine/olmesartan medoxomil 5/20 mg/d, 5/40 mg/d, and 10/40 mg/d. In patients with diabetes and obesity, baseline 24-hour ambulatory BP (± standard deviation) was 145.6 ± 10.4/83.1 ± 9.0 mm Hg and 143.7 ± 9.8/84.9 ± 8.2 mm Hg, respectively, and baseline SeBP was 159.1 ± 11.3/90.3 ± 9.2 mm Hg and 158.2 ± 12.5/94.2 ± 8.5mm Hg, respectively. Changes from baseline in mean 24-hour ambulatory BP (± standard error of the mean) were -21.5 ± 1.8/-12.6 ± 1.1 mm Hg and 21.6 ± 1.1/13.4 ± 0.8 mm Hg in patients with diabetes and obesity, respectively. Prespecified 24-hour ambulatory BP targets of < 130/80 mm Hg, < 125/75 mm Hg, and < 120/80 mm Hg were achieved by 79.1%, 53.5%, and 39.5% of patients with diabetes and 75.3%, 58.4%, and 43.8% of obese patients, respectively. The SeBP goal of < 130/80 mm Hg was achieved by 26.1% of patients with diabetes and <140/90 mm Hg was achieved by 78.1% of obese patients.     

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.     

An evaluation of the efficacy of olmesartan medoxomil in Black patients with hypertension

Blacks appear to have a more modest blood pressure (BP) response to angiotensin receptor blocker (ARB) monotherapy than non-Blacks. This post-hoc analysis compared the BP-lowering efficacy of olmesartan medoxomil (OM), losartan potassium (LOS), and valsartan (VAL) in Black versus non-Black participants in a randomized, forced-titration study. Patients were randomized to OM 20, LOS 50, and VAL 80 mg/day or placebo for 4 weeks and uptitrated to 40, 100, and 320 mg/day doses, respectively, by study end. The primary end point was the mean change from baseline in diastolic BP (DBP) at week 8. All treatments produced significant reductions in mean DBP and systolic BP (SBP) in Blacks (n = 150; P < .001). BP <140/90 mm Hg was achieved in 35.0%, 15.6%, 29.7%, and 5.0% of Blacks receiving OM, LOS, VAL, and placebo, respectively, and in 41.0%, 21.1%, 28.8%, and 14.5% of non-Blacks receiving OM, LOS, VAL, and placebo, respectively, after 8 weeks. BP-lowering efficacy of the three agents was similar at 3 months. OM had the greatest early efficacy, with numerically greater mean reductions in DBP and SBP, and a higher proportion of Black and non-Black patients achieving goal BP of 140/90 mm Hg at week 8.     

Stroke in patients with diabetes and hypertension

Stroke is major public health problem leading to increased morbidity and mortality. Modifiable risk factors for stroke include hypertension, diabetes, atrial fibrillation, dyslipidemia, smoking, and alcohol abuse. Among these risk factors, diabetes and hypertension are rapidly growing epidemics leading to a substantial increase in cardiovascular disease and stroke. In this review, the authors discuss the risk factors for stroke with emphasis on the diabetic and hypertensive population, highlighting the interventions that have been shown to decrease stroke risk in this patient population.     

Low-dose captopril titration in patients with moderate-to-severe hypertension treated with diuretics

To study the value of low-dose captopril (6.25 and 12.5 mg) and a diuretic combination, the blood pressure and heart rate of 17 patients with moderate-to-severe hypertension were monitored for 6 hours (hospital) or 3 hours (office) after the single low-dose or larger (25, 50, 100 and 150 mg) captopril dosage. All patients had preserved renal function and were taking an oral diuretic (hydrochlorothiazide or furosemide) for at least 4 weeks. The supine and upright acute blood pressure lowering with 6.25 mg was not different from the larger captopril doses; none produced persistent or profound hypotension. There was no deterioration of renal function, new or persistent increase in proteinuria, neutropenia or agranulocytosis acutely or during 17 +/- 2 weeks of follow-up. Low-dose captopril (6.25 or 12.5 mg three times daily) normalized the supine blood pressure of 35% of these patients acutely. We suggest that in hypertensive patients already taking a diuretic, a lower starting dose of captopril than the recommended 25 mg three times daily may be desirable.     

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。     

奥美沙坦酯和氨氯地平联合治疗原发性高血压的研究

目的:观察奥美沙坦酯和氨氯地平联合治疗控制血压的疗效和安全性。方法:70例2、3级高血压病患者随机接受奥美沙坦酯20 mg与氨氯地平5 mg联合治疗或缬沙坦80 mg与氨氯地平5 mg联合治疗,1次/d,总疗程8周。结果:奥美沙坦酯组和缬沙坦组治疗后血压下降幅度分别为(24.5±9.5/16.0±6.8)mm Hg(1 mm Hg=0.133 kPa)和(24.3±9.2/15.7±6.6)mm Hg,2组间差异无统计学意义(P>0.05)。奥美沙坦酯与氨氯地平和缬沙坦与氨氯地平联合治疗组降压总有效率分别为91.4%和88.6%,2组间差异无统计学意义(P>0.05)。2组不良反应发生率差异无统计学意义(P>0.05)。结论:2、3级高血压病治疗,奥美沙坦酯与氨氯地平和缬沙坦与氨氯地平联合治疗疗效和不良反应均类似。     

Treatment of hypertension in patients with diabetes

At least 17 million people in the United States have diabetes mellitus, and another 50 million have hypertension. These chronic diseases increasingly coexist in our aging population. Both diseases are important predisposing factors for the development of cardiovascular disease (CVD) and renal disease, and the coexistence of these risk factors is a very powerful promoter of CVD and renal disease. There is accumulating evidence that the rigorous treatment of hypertension and other risk factors such as dyslipidemia and hyperglycemia considerably lessens the burden of CVD and renal disease in patients with diabetes mellitus. There is considerable evidence that strategies addressing diet and exercise reduce the development of diabetes and are an important component of treatment in persons who have established diabetes. There are also considerable data suggesting that the treatment strategies that interrupt the renin-angiotensin system have special benefits in patients with diabetes and may prevent the development of clinical diabetes in hypertensive patients with impaired glucose tolerance. Data from a recent study indicate that the control of systolic blood pressure, using a diuretic agent as part of antihypertensive therapy, reduces the risk of stroke and other CVD end points. Recent reports indicate that angiotensin receptor-blocking agents decrease the rate of development of proteinuria and diabetic renal disease. These observations will likely have a significant impact on treatment of hypertension in patients with type 2 diabetes mellitus.     

老年糖尿病并高血压对心血管组织的影响

目的:探讨原发性糖尿病(DM)和高血压(EH)对老年人心血管病变的影响。方法:172名老年人按照血压、空腹血糖(FPG)、餐后2 h血糖(PG2 h)测定分为4组:健康对照组、DM组、EH组和EH伴DM组,每组43例。以超声波测量颈总动脉(CCA)、颈内动脉(ICA)内膜中层厚度(I MT),颈总动脉及颈内动脉最大血流速度(PSV)、颈总动脉及颈内动脉舒张末期血流速度(DV)、颈动脉阻力指数(RI)等指标;超声心动图测量左房内径(LAD)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDS)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室重量指数(LVMI)、相对室壁厚度(RWT)、peak E/A、左室短轴缩短率(FS)。结果:与健康对照组比较,DM组、EH组和EH+DM组的CCA-I MT和ICA-I MT显著增大,CCA-PV、ICA-PV显著降低(P0.05~0.01),EH组及EH+DM组的CCA-DV、ICA-DV显著减少(P0.05)。关于对心脏的影响,与健康对照组、DM组比较,EH组和EH+DM组的IVST、LVPWT、LVMI和RWT显著增大(P均0.05),E/A显著减小(P0.05)。EH组和EH+DM组的各项指标无显著差异(P0.05)。结论:高血压和糖尿病均能使颈动脉内膜中层厚度显著增厚,且高血压能引起心脏病变,为改善颈动脉病变应防治糖尿病和高血压。     

Evidence-based hypertension treatment in patients with diabetes

J Clin Hypertens (Greenwich). 2011;00:00–00. ©2011 Wiley Periodicals, Inc. Both impaired glucose tolerance and diabetes are associated with substantially increased prevalence of hypertension, cardiovascular and renal disease. The goal for hypertension treatment in diabetic patients is in evolution, because of recent clinical trials. For example, the results of the recent Action to Control Cardiovascular Risk in Diabetes—BP Arm (ACCORD BP) trial failed to show an additional benefit on cardiovascular event reduction at a mean systolic BP of 119 mm Hg. A post hoc analysis of 6,400 patients with type 2 diabetes from the International Verapamil‐Trandolapril Study (INVEST) also failed to show additional cardiovascular risk reduction among patients who achieved a BP <130/80 mm Hg. While the evidence fails to support a lower BP goal to reduce coronary events, there was a risk reduction in stroke events both in ACCORD and the Appropriate Blood Pressure Control in NIDDM (ABCD) trial. A number of other clinical trials also demonstrate that when systolic pressures fall to less than 130 mm Hg, a reduction in stroke but not coronary disease events occurs. Thus, the precise BP goal for diabetic patients remains unresolved. We would posit that a BP goal of 135/85 mm Hg may be a reasonable compromise when viewing the impact of BP reduction on composite stroke and coronary artery disease in extant trials.     

Management of hypertension in patients with diabetes: the place of angiotensin-II receptor blockers

Hypertension is an important cardiovascular (CV) risk factor in patients with diabetes mellitus. In this setting, tight control of blood pressure (BP) significantly reduces CV morbidity and mortality. In the UK Prospective Diabetes Study, a 10 mmHg reduction in systolic blood pressure (SBP) was superior to a 0.7% decrease in glycosylated haemoglobin A1c (HbA1c) as far as reducing morbidity and mortality was concerned. In the Hypertension Optimal Treatment study, the risk of CV events decreased by 51% among patients with type 2 diabetes randomized to the lower BP level. Based on these findings, contemporary treatment guidelines recommend a target SBP/diastolic blood pressure of <130/80 mmHg for patients with diabetes.