Key result
Switching from ARB or CCB monotherapy to a combination of olmesartan and azelnidipine increased the proportion of patients achieving both office and home blood pressure targets from 0% to 55%.
Why the study?
The study investigated whether a combination drug containing an ARB and a CCB could provide effective antihypertensive therapy in patients with uncontrolled BP despite monotherapy.
Does switching to a combination of olmesartan 20 mg and azelnidipine 16 mg improve blood pressure control in patients with uncontrolled hypertension on monotherapy?
Observational (n=78)
Open-label
Yes
Does switching to a combination of olmesartan 20 mg and azelnidipine 16 mg improve blood pressure control in patients with uncontrolled hypertension on monotherapy?
Absolute Event Rate: 55% vs 0%
Switching from ARB or CCB monotherapy to an olmesartan/azelnidipine combination significantly improves BP control, though real-world measurement accuracy by general practitioners may be compromised by digit preference.
May support ARB/CCB combinations in uncontrolled hypertension; hypothesis-generating and should not yet change practice without RCTs.
Background: This study investigated whether a combination drug containing an angiotensin II receptor blocker (ARB) and a calcium channel blocker (CCB) could provide effective antihypertensive therapy.Methods: A multicenter, prospective, open-label study was conducted at the clinics of Clinical Research Network. The subjects had uncontrolled blood pressure (BP) despite ARB or CCB monotherapy. The effect on both office and home BP was examined after patients switched to a combination drug (REZ: containing 20 mg of olmesartan [OL] and 16 mg of azelnidipine [AZ]).Results: A total of 78 patients were enrolled. After switching to REZ, a significant and sustained reduction of office BP was observed. The proportion of patients who achieved the target for both office and home BP was an increase from 0% to 55%. Switching from amlodipine to REZ resulted in a significant and sustained decrease of office and home BP. There was also a significant decrease of home pulse rate (PR), but office PR was unchanged. To determine the accuracy of the BP and PR values reported by patients, the frequency of each number as the first digit was determined. The frequency of “0” was extremely high for both office and home BP values, and the same was noted for home PR values.Conclusion: The results of this study suggested that switching from a single drug to combination therapy with REZ could achieve a stronger antihypertensive effect. However, concern was raised regarding the methods of BP and PR measurement and recording in this clinical trial involving general practitioners.
No takes yet. Share an insight, caveat, or question.
Okamura et al. (2019) conducted an observational in Uncontrolled blood pressure (n=78). REZ (olmesartan plus azelnidipine) vs. ARB or CCB monotherapy (baseline) was evaluated on Achievement of target for both office and home blood pressure. Switching from ARB or CCB monotherapy to a combination of olmesartan and azelnidipine increased the proportion of patients achieving both office and home blood pressure targets from 0% to 55%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: