Combination Therapy with Olmesartan/Hydrochlorothiazide to Improve Blood Pressure Control

Poor blood pressure (BP) control is a serious clinical problem, being responsible for much of the morbidity and mortality associated with arterial hypertension. Although European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines for the management of arterial hypertension strongly recommend to pursue the primary therapeutic goal of BP control in the population of hypertensive patients, currently available data indicate that, in the western world, a large proportion of hypertensive patients have poor BP control. Relevant causes of poor BP control are clinical inertia, defined as failure of physicians to modify or intensify treatment of patients who do not achieve BP targets, and low patient adherence to the treatment. Improved BP control can be achieved by using appropriate antihypertensive drugs at adequate dosage and/or improving patients' adherence rate. In the majority of hypertensive patients, a combination of two or more antihypertensive drugs is nearly always necessary in order to achieve adequate BP control as recommended by current ESH/ESC Guidelines. In such cases, the use of fixed-dose combinations can significantly improve patient adherence, through the reduction of daily “pill-burden”. Olmesartan medoxomil (OM) is an antihypertensive agent belonging to the angiotensin II receptor antagonist (ARB) class which, in several clinical studies, has proved to be effective and well tolerated in the treatment of hypertensive patients. In patients in whom olmesartan medoxomil monotherapy fails to achieve the recommended BP goal, the combination of olmesartan medoxomil with the thiazide diuretic hydrochlorothiazide (HCTZ) can enhance the efficacy of the antihypertensive treatment (compared with placebo and monotherapy with either agent), thereby allowing a greater number of patients to achieve BP control. Combination therapy with OM/HCTZ has shown good efficacy and a favorable tolerability profile in a number of clinical trials. In this review, we will examine the evidence in the literature on this subject and advance suggestions on the most rational way to use this therapy in clinical practice.