Enhanced Blood Pressure–Lowering Effect of Olmesartan in Hypertensive Patients With Chronic Kidney Disease–Associated Sympathetic Hyperactivity: HONEST Study |
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Authors: | Kazuomi Kario MD PhD Ikuo Saito MD PhD Toshio Kushiro MD PhD Satoshi Teramukai PhD Yoshihiro Mori MS Katsutoshi Hiramatsu MS Fumiaki Kobayashi MS Kazuyuki Shimada MD PhD |
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Institution: | 1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, , Shimotsuke, Japan;2. Keio University Health Center, , Yokohama, Japan;3. Health Planning Center, Nihon University School of Medicine, , Tokyo, Japan;4. Innovative Clinical Research Center, Kanazawa University, , Kanazawa, Japan;5. Daiichi Sankyo Co., Ltd, , Tokyo, Japan;6. Shin‐Oyama City Hospital, , Oyama, Japan |
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Abstract: | To investigate the blood pressure (BP)–lowering effect of olmesartan in relation to chronic kidney disease (CKD)–associated sympathetic nerve activity, a subanalysis was performed using data from the first 16 weeks of the Home BP Measurement With Olmesartan‐Naive Patients to Establish Standard Target Blood Pressure (HONEST) study, a prospective observational study of hypertensive patients. Essential hypertensive patients who took no antihypertensive agent at baseline were classified based on baseline morning home systolic BP (MHSBP) in quartiles. In each class, patients were further classified based on baseline morning home pulse rate (MHPR). A subgroup analysis in patients with/without chronic kidney disease (CKD) was performed. A total of 5458 patients (mean age, 63.0 years; 51.6% women) were included. In the 4th quartile of baseline MHSBP (≥165 mm Hg), patients with MHPR ≥70 beats per minute had a greater BP reduction (by 3.2 mm Hg) than those with MHPR <70 beats per minute after 16 weeks of olmesartan‐based treatment (P=.0005). An even greater BP reduction (by 6.6 mm Hg) was observed in patients with CKD than in patients without CKD in this group (P=.0084). Olmesartan was more effective in hypertensive patients with high MHSBP and MHPR ≥70 beats per minute, especially in patients with CKD. Olmesartan may have enhanced BP‐lowering effects by improving renal ischemia in hypertensive CKD patients with potential increased sympathetic nerve activity. |
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