Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients

Abstract

Effective antihypertensive therapy is crucial for preventing cardiovascular events; however, blood pressure (BP) control rates remain poor. The objective of this analysis was to determine the efficacy of olmesartan/amlodipine in age, severity and gender-based subgroups of patients with moderate-to-severe hypertension uncontrolled by amlodipine monotherapy. Patients with uncontrolled BP after 8 weeks' amlodipine 5 mg monotherapy (n=755) were randomized to continue amlodipine 5 mg or receive olmesartan (10–40 mg) plus amlodipine 5 mg for 8 weeks. Patients whose BP remained suboptimal were uptitrated to olmesartan/amlodipine 20/5, 40/5 or 40/10 mg. Changes in BP and numbers of controlled patients were calculated separately to assess efficacy in patients aged <65 or 65 years, in those with moderate or severe hypertension, and in males and females. The antihypertensive effects of olmesartan/amlodipine were similar in patients aged <65 and 65 years of age. Compared with patients with moderate hypertension at baseline, those with severe hypertension tended to show higher decreases in BP, but achieved lower goal rates despite this. Females showed larger mean reductions in diastolic (1.61 mm Hg; P=0.003) and systolic BP (1.72 mm Hg; P=0.053) than males, independent of age and dose. This gender difference appeared to be higher and more consistent across dose groups for patients <50 years of age, but the difference in the pattern between both age groups was not statistically significant (P=0.1526). These results suggest that olmesartan/amlodipine is effective and safe in a wide range of patients, regardless of age or hypertension severity. Small differences in responsiveness between females and males may exist, which require further investigation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J . Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004; 22: 11–19.

    Article  CAS  Google Scholar 

  2. Staessen JA, Li Y, Thijs L, Wang JG . Blood pressure reduction and cardiovascular prevention: an update including the 2003–2004 secondary prevention trials. Hypertens Res 2005; 28: 385–407.

    Article  Google Scholar 

  3. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS . Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 2007; 49: 69–75.

    Article  CAS  Google Scholar 

  4. UKPDS. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. Br Med J 1998; 317: 703–713.

    Article  Google Scholar 

  5. Staessen JA, Gasowski J, Wang JG, Thijs L, Hond ED, Boissel J-P . Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet 2000; 355: 865–872.

    Article  CAS  Google Scholar 

  6. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.

    Article  Google Scholar 

  7. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

    Article  CAS  Google Scholar 

  8. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.

    Article  CAS  Google Scholar 

  9. Wang YR, Alexander GC, Stafford RS . Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States. Arch Intern Med 2007; 167: 141–147.

    Article  Google Scholar 

  10. Redon J, Brunner HR, Ferri C, Hilgers KF, Kolloch R, van Montfrans G . Practical solutions to the challenges of uncontrolled hypertension: a white paper. J Hypertens 2008; 26: S1–14.

    Article  CAS  Google Scholar 

  11. Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grimm RH et al. Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens 2002; 4: 393–404.

    Article  Google Scholar 

  12. Law MR, Wald NJ, Morris JK, Jordan RE . Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. Br Med J 2003; 326: 1427.

    Article  CAS  Google Scholar 

  13. Moser M . Rationale for combination therapy in the management of hypertension. J Clin Hypertens 2003; 5: 17–25.

    Article  Google Scholar 

  14. Jamerson K, Weber MA, Bakris GL, Dahlof B, Pitt B, Shi V et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359: 2417–2428.

    Article  CAS  Google Scholar 

  15. Barrios V, Brommer P, Haag U, Calderon A, Escobar C . Olmesartan medoxomil plus amlodipine increases efficacy in patients with moderate-to-severe hypertension after monotherapy: a randomized, double-blind, parallel-group, multicentre study. Clin Drug Investig 2009; 29: 427–439.

    Article  CAS  Google Scholar 

  16. Chrysant SG, Melino M, Karki S, Lee J, Heyrman R . The combination of olmesartan medoxomil and amlodipine besylate in controlling high blood pressure: COACH, a randomized, double-blind, placebo-controlled, 8-week factorial efficacy and safety study. Clin Ther 2008; 30: 587–604.

    Article  CAS  Google Scholar 

  17. Volpe M, Brommer P, Haag U, Miele C . Efficacy and tolerability of olmesartan medoxomil combined with amlodipine in patients with moderate to severe hypertension after amlodipine monotherapy: a randomized, double-blind, parallel-group, multicentre study. Clin Drug Investig 2009; 29: 11–25.

    Article  CAS  Google Scholar 

  18. Mancia G, Bombelli M, Lanzarotti A, Grassi G, Cesana GC, Zanchetti A et al. Systolic vs diastolic blood pressure control in the hypertensive patients of the PAMELA population. Pressioni Arteriose Monitorate E Loro Associazioni. Arch Intern Med 2002; 162: 582–586.

    Article  Google Scholar 

  19. Wang TJ, Vasan RS . Epidemiology of uncontrolled hypertension in the United States. Circulation 2005; 112: 1651–1662.

    Article  Google Scholar 

  20. Kotsis V, Stabouli S, Pitiriga V, Papamichael C, Toumanidis S, Zakopoulos N . Impact of gender on 24-h ambulatory blood pressure and target organ damage. J Hum Hypertens 2006; 20: 658–665.

    Article  CAS  Google Scholar 

  21. Turnbull F, Woodward M, Neal B, Barzi F, Ninomiya T, Chalmers J et al. Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J 2008; 29: 2669–2680.

    Article  Google Scholar 

  22. Volpe M, Miele C, Haag U . Efficacy and safety of a Stepped-Care Regimen using olmesartan medoxomil, amlodipine and hydrochlorothiazide in patients with moderate-to-severe hypertension: an Open-Label, Long-Term Study. Clin Drug Investig 2009; 29: 381–391.

    Article  CAS  Google Scholar 

  23. Kannel WB, Gordan T . Evaluation of cardiovascular risk in the elderly: the Framingham study. Bull N Y Acad Med 1978; 54: 573–591.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D'Agostino RB et al. Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham Heart Study. JAMA 2002; 287: 1003–1010.

    Article  Google Scholar 

  25. Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. Br Med J 2008; 336: 1121–1123.

    CAS  Google Scholar 

  26. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887–1898.

    Article  CAS  Google Scholar 

  27. Mourad JJ, Le Jeune S . Effective systolic blood pressure reduction with olmesartan medoxomil/amlodipine combination therapy: post hoc analysis of data from a randomized, double-blind, parallel-group, multicentre study. Clin Drug Investig 2009; 29: 419–425.

    Article  CAS  Google Scholar 

  28. Mancia G, Grassi G . Systolic and diastolic blood pressure control in antihypertensive drug trials. J Hypertens 2002; 20: 1461–1464.

    Article  CAS  Google Scholar 

  29. Lloyd-Jones DM, Evans JC, Larson MG, Levy D . Treatment and control of hypertension in the community: a prospective analysis. Hypertension 2002; 40: 640–646.

    Article  CAS  Google Scholar 

  30. Weycker D, Edelsberg J, Vincze G, Levy DG, Kartashov A, Oster G . Blood pressure control in patients initiating antihypertensive therapy. Ann Pharmacother 2008; 42: 169–176.

    Article  Google Scholar 

  31. Banegas JR, Segura J, de la Sierra A, Gorostidi M, Rodriguez-Artalejo F, Sobrino J et al. Gender differences in office and ambulatory control of hypertension. Am J Med 2008; 121: 1078–1084.

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by Daiichi Sankyo Europe, the manufacturer of olmesartan/amlodipine. Medical writing services from Lucy Ebden (inScience Communications, a Wolters Kluwer Business, Auckland, NZ) and Amy McCallum (inScience Communications, a Wolters Kluwer Business, Chester, UK) were funded by Daiichi Sankyo Europe. We thank Dr Winfried Koch of HaaPACS GmbH, Schriesheim, Germany, for assistance with the statistical analysis of data presented in this report.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R E Schmieder.

Ethics declarations

Competing interests

Professor Dr Roland Schmieder has received lecture fees and research grants from Daiichi Sankyo. He is also a member of the Advisory Board. Professor Böhm has received speaker honoraria from Daiichi Sankyo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmieder, R., Böhm, M. Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients. J Hum Hypertens 25, 354–363 (2011). https://doi.org/10.1038/jhh.2010.74

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2010.74

Keywords

This article is cited by

Search

Quick links